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World Journal of Urology
Published in: World Journal of Urology 12/2019

01-12-2019 | Topic Paper

Oligorecurrent prostate cancer limited to lymph nodes: getting our ducks in a row

Nodal oligorecurrent prostate cancer

Authors: Andrei Fodor, Andrea Lancia, Francesco Ceci, Maria Picchio, Morten Hoyer, Barbara Alicja Jereczek-Fossa, Piet Ost, Paolo Castellucci, Elena Incerti, Nadia Di Muzio, Gianluca Ingrosso

Published in: World Journal of Urology | Issue 12/2019

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Abstract

Purpose

Oligorecurrent prostate cancer with exclusive nodal involvement represents a common state of disease, amenable to local therapy. New radio-labeled tracers have enriched the possibility of cancer detection and treatment. In this review, we aim to illustrate the main nuclear medicine diagnostic options and the role of radiotherapy in this setting of patients.

Methods

We performed a PubMed search referring to the PRISMA guidelines to analyze the performance of PSMA- and choline-PET in detecting oligorecurrence limited to lymph nodes, and to review the main studies supporting either ablative stereotactic body radiotherapy or regional lymph node irradiation in this clinical setting.

Results

PSMA-PET has shown higher efficacy in the diagnosis of nodal lesions if compared with choline-PET. More specifically, for PSA ≤ 2 ng/ml, the median detection rate of choline-PET ranges from 19.5 to 44.5%, whereas PSMA ranges from 51.5 to 74%. SBRT achieves high local control rates positively affecting progression-free survival (PFS), with androgen deprivation therapy (ADT)-free survival ranging from 25 to 44 months and with low toxicity rates (0–15%). Prophylactic nodal irradiation shows 3-year PFS rates ranging from 62 to 75%, but with a potential higher risk of toxicity. However, the chosen treatment option needs to be tailored on the single patient.

Conclusions

Newer PET/CT radio-labeled tracers have increased disease detection in oligorecurrent prostate cancer patients. Growing evidence of their impact on metastasis-directed therapy encourages the use of the most advanced radiotherapy techniques in the clinical management of such patients.
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Metadata
Title
Oligorecurrent prostate cancer limited to lymph nodes: getting our ducks in a row
Nodal oligorecurrent prostate cancer
Authors
Andrei Fodor
Andrea Lancia
Francesco Ceci
Maria Picchio
Morten Hoyer
Barbara Alicja Jereczek-Fossa
Piet Ost
Paolo Castellucci
Elena Incerti
Nadia Di Muzio
Gianluca Ingrosso
Publication date
01-12-2019
Publisher
Springer Berlin Heidelberg
Published in
World Journal of Urology / Issue 12/2019
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-018-2322-7

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