Andrei Fodor1, Andrea Lancia2, Francesco Ceci3, Maria Picchio4, Morten Hoyer5, Barbara Alicja Jereczek-Fossa6,7, Piet Ost8, Paolo Castellucci9, Elena Incerti4, Nadia Di Muzio1, Gianluca Ingrosso10. 1. Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy. 2. Department of Radiotherapy, Tor Vergata General Hospital, Viale Oxford 81, 00133, Rome, Italy. andrea.lancia.dr@gmail.com. 3. Department of Molecular and Medical Pharmacology, Ahmanson Translational Imaging Division, University of California at Los Angeles (UCLA), Los Angeles, USA. 4. Unit of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy. 5. Department of Oncology, Aarhus University Hospital, Aarhus, Denmark. 6. Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy. 7. Department of Radiation Oncology, European Institute of Oncology, Milan, Italy. 8. Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium. 9. Nuclear Medicine Unit, University of Bologna, S. Orsola Hospital Bologna, Bologna, Italy. 10. Department of Radiotherapy, Tor Vergata General Hospital, Viale Oxford 81, 00133, Rome, Italy.
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.
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 cancerpatients. 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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