title: Management of Node Only Recurrence after Primary Local Treatment for Prostate Cancer: A Systematic Review of the Literature.
abstract: OBJECTIVE
  We analyzed all available studies assessing the management of node only recurrence after primary local treatment of prostate cancer.
  
  
  METHODS
  We systematically reviewed the literature in January 2015 using the PubMed, Web of Sciences and Embase databases according to PRISMA guidelines. Studies exclusively reporting visceral or bone metastatic disease were excluded from analysis. Eight radiotherapy and 12 salvage lymph node dissection series were included in our qualitative study.
  
  
  RESULTS
  All 248 radiotherapy and 480 salvage lymph node dissection studies were single arm case series including a total of 728 patients. Choline positron emission tomography/computerized tomography was the reference imaging technique for nodal recurrence detection. Globally 50% of patients remained disease-free after short-term followup. Nevertheless, approximately two-thirds of patients received adjuvant hormone therapy, leading an overestimation of prostate specific antigen-free survival rates obtained after salvage treatment. Combining radiotherapy with salvage lymph node dissection may improve oncologic control in the treated region without improving the outfield relapse risk or the prostate specific antigen response. Great heterogeneity among series in adjuvant treatments, endpoints, progression definitions and study populations made it difficult to assess the precise impact of salvage treatment on the prostate specific antigen response and compare outcomes between radiotherapy and salvage lymph node dissection series. Toxicity after radiotherapy or salvage lymph node dissection was acceptable without frequent high grade complications. The benefit of early hormone therapy as the only salvage treatment remains unknown.
  
  
  CONCLUSIONS
  Although a high level of evidence is currently missing to draw any strong conclusion, published clinical series show that in select patients salvage treatment directed to nodal recurrence could lead to good oncologic outcomes. Although the optimal timing of androgen deprivation therapy in this setting is still unknown, such an approach could delay time to systemic treatment with an acceptable safety profile. Future prospective trials are awaited to better clarify this potential impact on well-defined endpoints.
authors.affiliation: Department of Urology, Saint Jean Languedoc Hospital, Toulouse, France; INSERM U955, Team 7, Paris Est University, Créteil, France. Electronic address: g.ploussard@gmail.com.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Ploussard
authors.affiliation: Department of Urology, Saint Jean Languedoc Hospital, Toulouse, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Almeras
authors.affiliation: Unit of Urology, Division of Oncology, Urological Research Institute, Istituti di Ricovero e Cura a Carattere Scientifico, Ospedale San Raffaele, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.affiliation: Department of Urology, University of Udine, Udine, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Giannarini
authors.affiliation: Department of Radiation Oncology, Saint Louis Hospital, Paris 7 University, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Hennequin
authors.affiliation: Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium.
authors.forename: Piet
authors.initials: P
authors.lastname: Ost
authors.affiliation: Department of Radiology, Pitié Salpétrière Hospital, Paris 6 University, Paris, France.
authors.forename: Raphaële
authors.initials: R
authors.lastname: Renard-Penna
authors.affiliation: Department of Urology, Saint Jean Languedoc Hospital, Toulouse, France.
authors.forename: Ambroise
authors.initials: A
authors.lastname: Salin
authors.affiliation: Department of Urology, Foch Hospital, Université Versailles St. Quentin en Yvelines, Suresnes, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lebret
authors.affiliation: Department of Urology, Lille University Medical Center, Lille University France, Lille, France.
authors.forename: Arnauld
authors.initials: A
authors.lastname: Villers
authors.affiliation: Department of Urology, Rangueil Hospital, University of Toulouse, Toulouse, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Soulié
authors.affiliation: Department of Urology, Mondor Hospital, Paris Est University, Créteil, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: de la Taille
authors.affiliation: Department of Urology, Lille University Medical Center, Lille University France, Lille, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Flamand
mesh_terms: D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000628:therapy*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000628:therapy*; D016879:Salvage Therapy
keywords: local; lymph node dissection; neoplasm recurrence; prostatic neoplasms; radiotherapy; salvage therapy