Salvage Therapy for Prostate Cancer - Salvage Therapy After Radiotherapy or Focal Therapy, Pelvic Nodal Recurrence and Oligometastasis, and Future Directions

Publication Date: February 13, 2024
Last Updated: April 2, 2024

Summary of Recommendations

For patients with BCR following primary RT or ablative therapy who have no evidence of metastatic disease and are candidates for local salvage therapy, clinicians should perform a prostate biopsy to evaluate for local recurrence. (Clinical Principle, )
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In patients with a biopsy-documented prostate cancer recurrence after primary RT who are candidates for salvage local therapy, clinicians should offer RP, cryoablation, high-intensity focused ultrasound (HIFU), or reirradiation as part of an SDM approach. (Moderate, C)
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In patients for whom salvage local therapy is being considered following focal ablation, clinicians should offer whole gland treatment by RP or RT. (Expert Opinion, )
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In patients with pelvic nodal recurrence following primary RP, clinicians should offer ADT plus salvage RT to the prostate bed and pelvic lymph nodes. (Expert Opinion, )
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In patients with pelvic nodal recurrence following primary RT who did not receive prior pelvic nodal RT, clinicians should offer salvage pelvic nodal RT plus ADT. (Expert Opinion, )
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Clinicians may offer salvage pelvic lymphadenectomy for patients with evidence of pelvic lymph node recurrence after RP or RT; however, these patients should be counseled regarding the uncertain oncologic benefit from surgery in this setting. (Conditional, C)
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In patients with evidence of regional or metastatic oligorecurrence following primary therapy (RP or RT), clinicians may perform stereotactic ablative radiotherapy (SABR) metastasis-directed therapy (MDT) but should consider the risk of toxicity versus benefits. (Conditional, C)
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In patients with BCR who have non-regional disease seen on PET/CT but no visible disease on conventional imaging, clinicians may omit salvage RT to the prostate bed and should discuss the uncertain role of systemic therapy in this setting. (Expert Opinion, )
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Recommendation Grading

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Salvage Therapy for Prostate Cancer - Salvage Therapy After Radiotherapy or Focal Therapy, Pelvic Nodal Recurrence and Oligometastasis, and Future Directions

Authoring Organizations

American Society for Radiation Oncology

American Urological Association

Society of Urologic Oncology

Publication Month/Year

February 13, 2024

Last Updated Month/Year

April 2, 2024

Supplemental Implementation Tools

Document Type

Guideline

Country of Publication

US

Document Objectives

The summary presented herein covers recommendations on salvage therapy for recurrent prostate cancer intended to facilitate care decisions and aid clinicians in caring for patients who have experienced a recurrence following prior treatment with curative intent. This is Part III of a three-part series focusing on evaluation and management of suspected non-metastatic recurrence after radiotherapy (RT) and focal therapy, evaluation and management of regional recurrence, management for molecular imaging metastatic recurrence, and future directions. Please refer to Part I for discussion of treatment decision-making and Part II for discussion of treatment delivery for non-metastatic biochemical recurrence (BCR) after radical prostatectomy (RP).

Inclusion Criteria

Male, Female, Adult, Infant

Health Care Settings

Ambulatory, Outpatient, Radiology services

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management

Keywords

prostate cancer, salvage therapy, Oligometastasis, Pelvic Nodal Recurrence

Source Citation

Morgan, Todd M.*; Boorjian, Stephen A.; Buyyounouski, Mark K.; Chapin, Brian F.; Chen, David Y. T.; Cheng, Heather H.; Chou, Roger; Jacene, Heather A.; Kamran, Sophia C.; Kim, Sennett K.; Kirkby, Erin; Luckenbaugh, Amy N.; Nathanson, Ben J.; Nyame, Yaw A.; Posadas, Edwin M.; Tran, Phuoc T.; Chen, Ronald C. Salvage Therapy for Prostate Cancer: AUA/ASTRO/SUO Guideline Part III: Salvage Therapy After Radiotherapy or Focal Therapy, Pelvic Nodal Recurrence and Oligometastasis, and Future Directions, Journal of Urology:  - Volume 0 - Issue 0 doi: 10.1097/JU.0000000000003890

Supplemental Methodology Resources

Data Supplement

Methodology

Number of Source Documents
34
Literature Search Start Date
July 20, 2022
Literature Search End Date
July 25, 2023