Post-Operative Radiotherapy in Prostate Cancer: Is It Time for a Belt and Braces Approach?

Approximately 30% of patients treated with radical prostatectomy (RP) for prostate cancers experience biochemical recurrence (BCR). Post-operative radiation therapy (RT) can be either offered immediately after the surgery in case of aggressive pathological features or proposed early if BCR occurs. U...

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Autores principales:	Nicolas Giraud, Nicolas Benziane-Ouaritini, Ulrike Schick, Jean-Baptiste Beauval, Ahmad Chaddad, Tamim Niazi, Mame Daro Faye, Stéphane Supiot, Paul Sargos, Igor Latorzeff
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	prostate cancer radiotherapy radical prostatectomy biochemical progression androgen deprivation therapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/ce1ee3b582eb43c3b4c51eb198d77f9e
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spelling	oai:doaj.org-article:ce1ee3b582eb43c3b4c51eb198d77f9e2021-11-22T13:17:35ZPost-Operative Radiotherapy in Prostate Cancer: Is It Time for a Belt and Braces Approach?2234-943X10.3389/fonc.2021.781040https://doaj.org/article/ce1ee3b582eb43c3b4c51eb198d77f9e2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fonc.2021.781040/fullhttps://doaj.org/toc/2234-943XApproximately 30% of patients treated with radical prostatectomy (RP) for prostate cancers experience biochemical recurrence (BCR). Post-operative radiation therapy (RT) can be either offered immediately after the surgery in case of aggressive pathological features or proposed early if BCR occurs. Until recently, little data were available regarding the optimal RT timing, protocol, volumes to treat, and the benefit of adding androgen deprivation therapies to post-operative RT. In this review, we aim to pragmatically discuss current literature data on these points. Early salvage RT appears to be the optimal post-operative approach, improving oncological outcomes especially with low prostate-specific antigen (PSA) levels, as well as sparing several unnecessary adjuvant treatments. The standard RT dose is still 64–66 Gy to the prostate bed in conventional fractionation, but hypofractionation protocols are emerging pending on late toxicity data. Several scientific societies have published contouring atlases, even though they are heterogeneous and deserve future consensus. During salvage RT, the inclusion of pelvic lymph nodes is also controversial, but preliminary data show a possible benefit for PSA > 0.34 ng/ml at the cost of increased hematological side effects. Concomitant ADT and its duration are also discussed, possibly advantageous (at least in terms of metastasis-free survival) for PSA rates over 0.6 ng/ml, taking into account life expectancy and cardiovascular comorbidities. Intensified regimens, for instance, with new-generation hormone therapies, could further improve outcomes in carefully selected patients. Finally, recent advances in molecular imaging, as well as upcoming breakthroughs in genomics and artificial intelligence tools, could soon reshuffle the cards of the current therapeutic strategy.Nicolas GiraudNicolas Benziane-OuaritiniUlrike SchickJean-Baptiste BeauvalAhmad ChaddadTamim NiaziMame Daro FayeStéphane SupiotPaul SargosIgor LatorzeffFrontiers Media S.A.articleprostate cancerradiotherapyradical prostatectomybiochemical progressionandrogen deprivation therapyNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENFrontiers in Oncology, Vol 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	prostate cancer radiotherapy radical prostatectomy biochemical progression androgen deprivation therapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	prostate cancer radiotherapy radical prostatectomy biochemical progression androgen deprivation therapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Nicolas Giraud Nicolas Benziane-Ouaritini Ulrike Schick Jean-Baptiste Beauval Ahmad Chaddad Tamim Niazi Mame Daro Faye Stéphane Supiot Paul Sargos Igor Latorzeff Post-Operative Radiotherapy in Prostate Cancer: Is It Time for a Belt and Braces Approach?
description	Approximately 30% of patients treated with radical prostatectomy (RP) for prostate cancers experience biochemical recurrence (BCR). Post-operative radiation therapy (RT) can be either offered immediately after the surgery in case of aggressive pathological features or proposed early if BCR occurs. Until recently, little data were available regarding the optimal RT timing, protocol, volumes to treat, and the benefit of adding androgen deprivation therapies to post-operative RT. In this review, we aim to pragmatically discuss current literature data on these points. Early salvage RT appears to be the optimal post-operative approach, improving oncological outcomes especially with low prostate-specific antigen (PSA) levels, as well as sparing several unnecessary adjuvant treatments. The standard RT dose is still 64–66 Gy to the prostate bed in conventional fractionation, but hypofractionation protocols are emerging pending on late toxicity data. Several scientific societies have published contouring atlases, even though they are heterogeneous and deserve future consensus. During salvage RT, the inclusion of pelvic lymph nodes is also controversial, but preliminary data show a possible benefit for PSA > 0.34 ng/ml at the cost of increased hematological side effects. Concomitant ADT and its duration are also discussed, possibly advantageous (at least in terms of metastasis-free survival) for PSA rates over 0.6 ng/ml, taking into account life expectancy and cardiovascular comorbidities. Intensified regimens, for instance, with new-generation hormone therapies, could further improve outcomes in carefully selected patients. Finally, recent advances in molecular imaging, as well as upcoming breakthroughs in genomics and artificial intelligence tools, could soon reshuffle the cards of the current therapeutic strategy.
format	article
author	Nicolas Giraud Nicolas Benziane-Ouaritini Ulrike Schick Jean-Baptiste Beauval Ahmad Chaddad Tamim Niazi Mame Daro Faye Stéphane Supiot Paul Sargos Igor Latorzeff
author_facet	Nicolas Giraud Nicolas Benziane-Ouaritini Ulrike Schick Jean-Baptiste Beauval Ahmad Chaddad Tamim Niazi Mame Daro Faye Stéphane Supiot Paul Sargos Igor Latorzeff
author_sort	Nicolas Giraud
title	Post-Operative Radiotherapy in Prostate Cancer: Is It Time for a Belt and Braces Approach?
title_short	Post-Operative Radiotherapy in Prostate Cancer: Is It Time for a Belt and Braces Approach?
title_full	Post-Operative Radiotherapy in Prostate Cancer: Is It Time for a Belt and Braces Approach?
title_fullStr	Post-Operative Radiotherapy in Prostate Cancer: Is It Time for a Belt and Braces Approach?
title_full_unstemmed	Post-Operative Radiotherapy in Prostate Cancer: Is It Time for a Belt and Braces Approach?
title_sort	post-operative radiotherapy in prostate cancer: is it time for a belt and braces approach?
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/ce1ee3b582eb43c3b4c51eb198d77f9e
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Post-Operative Radiotherapy in Prostate Cancer: Is It Time for a Belt and Braces Approach?

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