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American Radium Society Appropriate Use Criteria for the Workup and Treatment of Local Intraprostatic Recurrence of
Luca F Valle1, Tommy Jiang2, Ashton Rosenbloom3
1Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, CA, USA; Greater Los Angeles VA Medical Center, Los Angeles, CA, USA.
European Urology Oncology
|September 22, 2024
Summary
Local intraprostatic recurrence of prostate cancer requires careful workup and salvage intervention. Guidelines recommend PSMA PET and MRI for staging, biopsy before salvage, and preferred reirradiation approaches to improve outcomes.
Area of Science:
- Oncology
- Radiotherapy
- Urology
Background:
- Local intraprostatic recurrence of prostate cancer (IPR-PC) can lead to aggressive disease and reduced survival.
- Effective local salvage interventions can be curative but lack defined best practices for workup and treatment.
- The American Radium Society (ARS) aimed to establish evidence-based recommendations for IPR-PC management.
Purpose of the Study:
- To develop evidence-based recommendations for the workup and local salvage of intraprostatic recurrence of prostate cancer.
- To address the gap in best practices for managing IPR-PC.
- To provide guidance for multidisciplinary expert panels.
Main Methods:
- Searched PubMed and Embase for relevant peer-reviewed articles on IPR-PC workup and treatment.
- Evaluated and summarized literature, creating clinical variants for expert panel voting.
- Utilized a modified Delphi approach for multidisciplinary expert panel recommendations.
Main Results:
- Recommended radiographic staging with prostate-specific membrane antigen positron emission tomography (PSMA PET) and multiparametric MRI to identify metastatic disease and local recurrence extent.
- Stressed the necessity of biopsy before local salvage to prevent unnecessary toxicity.
- Advocated for local salvage over hormonal manipulation alone, favoring reirradiation approaches and short-term hormonal therapy for radiosensitization.
Conclusions:
- Established consensus guidelines for appropriate workup and treatment of IPR-PC.
- Highlighted the need for prospective evidence to further refine these guidelines.
- Provided a tool for clinicians to discuss optimal treatment strategies maximizing cure and minimizing side effects.
Keywords:
Hormone therapyLocal salvagePositron emission tomographyProstate cancerProstate-specific membrane antigenRadiorecurrent diseaseRadiotherapyTreatmentWorkup
