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Radiation Therapy After Radical Prostatectomy: What Has Changed Over Time?

Zattoni, F; Heidegger, I; Kasivisvanathan, V; Kretschmer, A; Marra, G; Magli, A; Preisser, F; ... Gandaglia, G; + view all (2021) Radiation Therapy After Radical Prostatectomy: What Has Changed Over Time? Frontiers in Surgery , 8 , Article 691473. 10.3389/fsurg.2021.691473. Green open access

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Abstract

The role and timing of radiotherapy (RT) in prostate cancer (PCa) patients treated with radical prostatectomy (RP) remains controversial. While recent trials support the oncological safety of early salvage RT (SRT) compared to adjuvant RT (ART) in selected patients, previous randomized studies demonstrated that ART might improve recurrence-free survival in patients at high risk for local recurrence based on adverse pathology. Although ART might improve survival, this approach is characterized by a risk of overtreatment in up to 40% of cases. SRT is defined as the administration of RT to the prostatic bed and to the surrounding tissues in the patient with PSA recurrence after surgery but no evidence of distant metastatic disease. The delivery of salvage therapies exclusively in men who experience biochemical recurrence (BCR) has the potential advantage of reducing the risk of side effects without theoretically compromising outcomes. However, how to select patients at risk of progression who are more likely to benefit from a more aggressive treatment after RP, the exact timing of RT after RP, and the use of hormone therapy and its duration at the time of RT are still open issues. Moreover, what the role of novel imaging techniques and genomic classifiers are in identifying the most optimal post-operative management of PCa patients treated with RP is yet to be clarified. This narrative review summarizes most relevant published data to guide a multidisciplinary team in selecting appropriate candidates for post-prostatectomy radiation therapy.

Type: Article
Title: Radiation Therapy After Radical Prostatectomy: What Has Changed Over Time?
Open access status: An open access version is available from UCL Discovery
DOI: 10.3389/fsurg.2021.691473
Publisher version: http://dx.doi.org/10.3389/fsurg.2021.691473
Language: English
Additional information: Copyright © 2021 Zattoni, Heidegger, Kasivisvanathan, Kretschmer, Marra, Magli, Preisser, Tilki, Tsaur, Valerio, van den Bergh, Kesch, Ceci, Fankhauser and Gandaglia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Keywords: adjuvant radiotherapy, salvage radiotherapy, biochemical recurrence, hormonal therapy, genomic classifiers, EARLY SALVAGE RADIOTHERAPY, ANDROGEN DEPRIVATION THERAPY, QUALITY-OF-LIFE, ADJUVANT RADIOTHERAPY, NATURAL-HISTORY, ANTIGEN PERSISTENCE, CANCER, SURVIVAL, RISK, RECURRENCE
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Targeted Intervention
URI: https://discovery.ucl.ac.uk/id/eprint/10132714
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