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Minerva Urologica e Nefrologica 2020 Aug 04

DOI: 10.23736/S0393-2249.20.03783-2

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Minimally invasive strategies for the treatment of prostate cancer recurrence after radiation therapy: a systematic review

Guglielmo MANTICA 1, Francesco CHIERIGO 1 , Nazareno SUARDI 1, Juan Gomez RIVAS 2, Veeru KASIVISVANATHAN 3, Rocco PAPALIA 4, Cristian FIORI 5, Francesco PORPIGLIA 5, Carlo TERRONE 1, Francesco ESPERTO 4, on behalf of ESRU (European Society of Residents in Urology)

1 Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy; 2 Department of Urology, La Paz University Hospital, Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid, Spain; 3 UCL Division of Surgery & Interventional Science, University College London, London, UK; 4 Department of Urology, Campus Biomedico University of Rome, Rome, Italy; 5 Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy


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INTRODUCTION: The aim of this review was to conduct a comprehensive analysis of the role of minimally invasive salvage modalities in radio-recurrent prostate cancer and the associated clinical outcomes and toxicity profiles.
EVIDENCE ACQUISITION: A systematic review of the current literature was conducted through the Medline and NCBI PubMed, Scopus databases in January 2020. All papers published after 2000, concerning studies conducted on humans for radio-recurrent prostate cancer were considered for the review.
EVIDENCE SYNTHESIS: Overall, 545 studies were identified. After duplicate exclusion, initial screening, and eligibility evaluation, a total of 80 studies were included in the qualitative analysis, corresponding to a cohort of 6681 patients. The median age at initial diagnosis ranged from 59 to 75.5. Pre-treatment PSA ranged from 6.2 to 27.4 ng/ml. All patients underwent primary radiotherapy for localized prostate cancer. Cryotherapy, Brachytherapy, EBRT, HIFU were the minimally invasive options mostly used as salvage therapy. They showed to be promising approaches for recurrent PCa control, with acceptable toxicities.
CONCLUSIONS: Minimally invasive therapeutic options offer promising results in terms of biochemical control in the local recurrence setting. Unfortunately, the absence of high quality and comparative studies makes it difficult to establish which method is the best in terms of oncological and safety outcomes.


KEY WORDS: Prostate cancer; Salvage radiotherapy; Salvage HIFU; Salvage cryotherapy; Salvage prostatectomy

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