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dc.contributor.authorKishan, AU
dc.contributor.authorTendulkar, RD
dc.contributor.authorTran, PT
dc.contributor.authorParker, CC
dc.contributor.authorNguyen, PL
dc.contributor.authorStephenson, AJ
dc.contributor.authorCarrie, C
dc.date.accessioned2021-03-01T14:46:18Z
dc.date.available2021-03-01T14:46:18Z
dc.date.issued2018-05-15
dc.identifier.citationEuropean urology oncology, 2018, 1 (1), pp. 3 - 18
dc.identifier.issn2588-9311
dc.identifier.urihttps://repository.icr.ac.uk/handle/internal/4380
dc.identifier.eissn2588-9311
dc.identifier.doi10.1016/j.euo.2018.02.008
dc.description.abstractContext Currently, salvage radiotherapy (SRT) is the only known curative intervention for men with recurrent disease following prostatectomy. Critical issues in the optimal selection and management of men being considered for SRT include the threshold prostate-specific antigen (PSA) value at which to initiate treatment (ie, pre-SRT PSA) and the role of concurrent hormonal therapy (HT).Objective To review the published evidence pertaining to the optimal timing for SRT and the role of concurrent HT.Evidence acquisition MEDLINE (via PubMed), EMBASE, the Cochrane Central Register of Controlled Trials, and guideline statements from professional organizations were queried from January 1, 2000 through January 10, 2018.Evidence synthesis Thirty-three independent reports, including two randomized trials evaluating HT with SRT, were identified. Retrospective data suggest that SRT initiation at lower pre-SRT PSA levels is associated with better clinical outcomes. Prospective data suggest an overall survival benefit with concurrent HT that manifests during long-term follow-up, with the caveat that hypothesis-generating subgroup analyses suggest that this benefit may be limited to patients with higher pre-SRT PSA levels. Patients with adverse risk factors, such as Gleason grade group 4-5 disease, are likely to benefit the most from earlier SRT initiation and/or the use of HT.Conclusions Given the limitations of the available data, it is imperative that physicians participate in shared decision-making, with the recommendation tailored for each man's desire to maximize oncologic benefit (with a risk of overtreatment) versus potential quality-of-life optimization (with a risk of undertreatment). Within that framework, a significant body of retrospective data supports initiation of SRT at low pre-SRT PSA values, without an arbitrary absolute threshold. Prospective data suggest a benefit of HT, but this benefit may be greatest in patients with a pre-SRT PSA that is higher than the typical level in most patients receiving "early" SRT. Further research is necessary before absolute recommendations can be made.Patient summary Two ways to potentially improve outcomes following salvage radiotherapy for prostate cancer that recurs after prostatectomy are to start treatment at a lower prostate-specific antigen level and to use concurrent hormonal therapy. Our review suggests that the available evidence is imperfect, but highlights that both measures are likely to improve clinical outcomes in general, but perhaps not uniformly and/or consistently for all patients. Physician-patient shared decision-making and further research are critical.
dc.formatPrint-Electronic
dc.format.extent3 - 18
dc.languageeng
dc.language.isoeng
dc.rights.urihttps://www.rioxx.net/licenses/all-rights-reserved
dc.subjectHumans
dc.subjectProstatic Neoplasms
dc.subjectNeoplasm Recurrence, Local
dc.subjectKallikreins
dc.subjectProstate-Specific Antigen
dc.subjectAntineoplastic Agents, Hormonal
dc.subjectTreatment Outcome
dc.subjectSalvage Therapy
dc.subjectSurvival Analysis
dc.subjectPhysician-Patient Relations
dc.subjectDecision Making
dc.subjectAged
dc.subjectMiddle Aged
dc.subjectMale
dc.subjectRandomized Controlled Trials as Topic
dc.subjectNeoplasm Grading
dc.subjectChemoradiotherapy
dc.subjectTime-to-Treatment
dc.titleOptimizing the Timing of Salvage Postprostatectomy Radiotherapy and the Use of Concurrent Hormonal Therapy for Prostate Cancer.
dc.typeJournal Article
dcterms.dateAccepted2018-02-12
rioxxterms.versionAM
rioxxterms.versionofrecord10.1016/j.euo.2018.02.008
rioxxterms.licenseref.urihttps://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2018-05-15
rioxxterms.typeJournal Article/Review
dc.relation.isPartOfEuropean urology oncology
pubs.issue1
pubs.notesNot known
pubs.organisational-group/ICR
pubs.organisational-group/ICR/Primary Group
pubs.organisational-group/ICR/Primary Group/Royal Marsden Clinical Units
pubs.organisational-group/ICR
pubs.organisational-group/ICR/Primary Group
pubs.organisational-group/ICR/Primary Group/Royal Marsden Clinical Units
pubs.publication-statusPublished
pubs.volume1en_US
pubs.embargo.termsNot known
dc.contributor.icrauthorParker, Chris


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