Different nonsurgical therapeutic strategies can be adopted for intraprostatic relapse of prostate cancer after primary radiotherapy, including re-irradiation (with brachytherapy [BT] or external beam radiotherapy [EBRT]), high-intensity focused ultrasound (HIFU), and cryotherapy. The main issues to consider when choosing nonsurgical salvage local therapies are local tumor control and significant genitourinary toxicity.

To conduct a systematic review and meta-analysis of the role of nonsurgical salvage modalities in patients with radiorecurrent prostate cancer and associated clinical outcomes and toxicity profiles.

We performed a critical review of the Medline, Scopus, and ClinicalKey databases from January 1, 2000 through February 1, 2018 according to the Preferred Reporting Items and Meta-Analyses statement. To assess the overall quality of the literature reviewed, we used a modified Delphi tool for case-series studies.

A total of 64 case-series studies were included, corresponding to a cohort of 5585 patients. The modified Delphi checklist evidenced high methodological quality overall (mean quality score of 80.6%). Biochemical control rates were lowest for patients treated with HIFU (58%, 95% confidence interval [CI] 47-68%) and highest for patients treated with BT (69%, 95% CI 62-76%) and EBRT (69%, 95% CI 53-83%). The lowest prevalence of incontinence was for patients treated with BT (3%, 95% CI 0-6%; I2=63.4%) and the highest was among patients treated with HIFU (28%, 95% CI 19-38%; I2=89.7%).

Nonsurgical therapeutic options, especially BT, showed good outcomes in terms of biochemical control and tolerability in the local recurrence setting.

The current analysis demonstrated that nonsurgical salvage local therapies offer a chance of a curative local approach in radiorecurrent prostate cancer. However, high-quality data from prospective trials are needed to validate long-term outcomes from nonsurgical strategies for the treatment of intraprostatic recurrence after previous radiotherapy.

European urology oncology. 2019 Jan 24 [Epub ahead of print]

Gianluca Ingrosso, Carlotta Becherini, Andrea Lancia, Saverio Caini, Piet Ost, Giulio Francolini, Morten Høyer, Marta Bottero, Alberto Bossi, Thomas Zilli, Daniele Scartoni, Lorenzo Livi, Riccardo Santoni, Irene Giacomelli, Beatrice Detti

Department of Radiation Oncology, Tor Vergata General Hospital, University of Rome “Tor Vergata”, Rome, Italy., Department of Radiation Oncology, A.O.U. Careggi, University of Florence, Florence, Italy., Radiation Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy. Electronic address: ., Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Networking, Florence, Italy., Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium., Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark., Department of Radiotherapy, Gustave-Roussy Institute, Villejuif, France., Radiation Oncology, Geneva University Hospital, Geneva, Switzerland., Proton Treatment Center, Azienda Provinciale per i Servizi Sanitari, Trento, Italy.