Local Salvage Therapies in Radiation Recurrent Prostate Cancer ? Are they Beneficial?

18 Mar, 21

Introduction

Despite curative intent, a significant proportion of prostate cancer (PCa) patients experience recurrence. Local salvage therapies such as salvage radiotherapy (RT), cryoablation, high-intensity focal ultrasound (HIFU) and radical prostatectomy (RP) might be beneficial to such patients. However, salvage therapies are underutilized due to lack of high-quality data, treatment-related adverse effects and lack of consensus on treatment algorithm. There is limited evidence on the functional outcomes and quality of life after local salvage therapies in patients with radiation recurrent PCa.

Aim

This review evaluates the rate and severity of functional outcomes after local salvage therapy for radiation recurrent PCa.

Method

Study Design

Systematic review

Treatment Strategy

After an extensive literature search using the MEDLINE/PubMed database, 35 studies were included
These studies assessed the functional outcomes of salvage RP, brachytherapy (BT), HIFU and cryotherapy (CT) after failure of primary radiation therapy.
Data on pre- and post-salvage rates and severity of functional outcomes were analyzed

Endpoints

Urinary incontinence (UI)
Erectile dysfunction (ED)
Median/mean of the International Prostate Symptom Score (IPSS)
International Index of Erectile Function (IIEF-5)

Results

The rates of severe UI and ED post salvage therapies are shown in Table 1.

Table 1. Rates of severe UI and ED post salvage therapies

	RT	HIFU	CT	BT
Rates of UI	28-88%	4.5-42%	0-6.5%	2.4-8%
Rates of ED	90%	94.6%	100%	62%

The high pre-salvage rates of ED preclude accurate estimation of the effect of salvage therapy
An increase in the median IPSS ranging from 2.5–3.4, 3.5–12, and 2, was demonstrated following salvage HIFU, BT and CT respectively.
Return-to-baseline IPSS after extended follow up was reported in a salvage BT study.
Inter-study comparisons seem inappropriate as the reported data due to selection, reporting, publication and period of study biases.

Conclusion

Local salvage therapies after radiation recurrent prostate cancer (PCa) negatively impact the continence, lower urinary tract symptoms and sexual functions.
Despite these adverse consequences, there are oncological benefits associated with use of local salvage therapy post radiation failure in select patients.
The decision to use local salvage therapies should be made with the informed patient in a shared decision working process.

Cancers (Basel). 2021 Jan; 13(2): 244. Doi: 10.3390/cancers13020244.