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Review
. 2021 Jan 11;13(2):244.
doi: 10.3390/cancers13020244.

Functional Outcomes after Local Salvage Therapies for Radiation-Recurrent Prostate Cancer Patients: A Systematic Review

Mohammad Abufaraj  1   2 , Abdelmuez Siyam  2 , Mustafa Rami Ali  2 , Rodrigo Suarez-Ibarrola  3 , Lin Yang  4   5 , Beat Foerster  6 , Shahrokh F Shariat  1   2   7   8   9   10
Affiliations
Review

Functional Outcomes after Local Salvage Therapies for Radiation-Recurrent Prostate Cancer Patients: A Systematic Review

Mohammad Abufaraj et al. Cancers (Basel). .

Abstract

Purpose: To assess the rate and severity of functional outcomes after salvage therapy for radiation recurrent prostate cancer.

Methods: This systematic review of the MEDLINE/PubMed database yielded 35 studies, evaluating salvage radical prostatectomy (RP), brachytherapy (BT), high-intensity focal ultrasound (HIFU) and cryotherapy (CT) after failure of primary radiation therapy. Data on pre- and post-salvage rates and severity of functional outcomes (urinary incontinence, erectile dysfunction, and lower urinary tract symptoms) were collected from each study.

Results: The rates of severe urinary incontinence ranged from 28-88%, 4.5-42%, 0-6.5%, 2.4-8% post salvage RP, HIFU, CT and BT, respectively. The rates of erectile dysfunction were relatively high reaching as much as 90%, 94.6%, 100%, 62% following RP, HIFU, CT and BT, respectively. Nonetheless, the high pre-salvage rates of ED preclude accurate estimation of the effect of salvage therapy. There was an increase in the median IPSS following salvage HIFU, BT and CT ranging from 2.5-3.4, 3.5-12, and 2, respectively. Extended follow-up showed a return-to-baseline IPSS in a salvage BT study. The reported data suffer from selection, reporting, publication and period of study biases, making inter-study comparisons inappropriate.

Conclusions: local salvage therapies for radiation recurrent PCa affect continence, lower urinary tract symptoms and sexual functions. The use of local salvage therapies may be warranted in the setting of local disease control, but each individual decision must be made with the informed patient in a shared decision working process.

Keywords: functional outcomes; local therapy; morbidity; prostate cancer; radiation recurrence; salvage therapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The Preferred Reporting in Systematic Reviews and meta-Analyses flowchart for article selection.
See this image and copyright information in PMC

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