Stereotactic radiotherapy for prostate bed recurrence after prostatectomy, a multicentric series

Area of Science:

• Oncology
• Radiation Oncology
• Urology

Background:

• Prostate cancer recurrence after initial treatment is a clinical challenge.
• Macroscopic recurrence in the prostate bed requires effective salvage strategies.
• Stereotactic salvage radiotherapy (SSRT) is an emerging treatment modality.

Purpose of the Study:

• To evaluate the safety and efficacy of SSRT for prostate bed macroscopic recurrence in radiation therapy-naïve patients.
• To assess biochemical recurrence-free survival (BCRFS) using distinct PSA thresholds.
• To determine the impact of SSRT on the need for androgen-deprivation therapy (ADT).

Main Methods:

• A retrospective review of 90 patients treated with SSRT (30-40 Gy in 5 fractions) across three Italian centers.
• Patients had macroscopic prostate bed recurrence and were naïve to prior radiation therapy.
• Biochemical recurrence-free survival was defined using two criteria: BCRFS1 (>10% PSA increase) and BCRFS2 (specific PSA level changes).

Main Results:

• Complete biochemical response (PSA nadir <0.2 ng/mL) was achieved in 43.3% of patients.
• Biochemical recurrence was observed in 27.8% (BCRFS1) and 35.5% (BCRFS2) of patients.
• No Grade >2 toxicity was reported, and 19% of patients received concomitant ADT during SSRT.

Conclusions:

• SSRT demonstrates significant potential for achieving biochemical control in recurrent prostate cancer.
• The treatment allows for a delay in initiating ADT, even in patients with unfavorable prognostic factors.
• SSRT is a safe and effective option for managing macroscopic prostate bed recurrence.