Top Line: How aggressively should you manage isolated nodal recurrence of prostate cancer?
The Study: This scenario largely captures what is meant by the art of oncology with a wide array of options that fall all along the aggressiveness spectrum. The single-arm phase 2 OLIGOPELVIS (GETUG-P07) trial delivered 6 months of ADT with salvage radiation of 54 Gy in 28 fractions to standard pelvic nodal volumes for 67 men with isolated recurrence in ≤5 pelvic nodes per fluorocholine PET restaging upon biochemical recurrence after prior definitive treatment: 37 were s/p definitive surgery or prostate-alone radiation and 30 were s/p surgery and salvage prostate bed-alone radiation. Importantly, these were largely aggressive biochemical recurrences with a median PSA doubling time of 4–5 months and a median absolute PSA level of 3-4. Median time to next biochemical recurrence was 2.2 years, and late toxicity was <5%. Five-year outcomes are now available and demonstrate one-third of patients remain without biochemical recurrence at five years. What’s more, subsequent nodal failure occurred in 14 (21%): 4 developed after receiving 54 Gy, 5 after failing to receive 54 Gy when they should have per RTOG volumes, and 8 outside standard volumes (think inguinal but mostly para-aortic nodes). Another 7 (10%) developed subsequent prostate bed failure, all of which had received at least 54 Gy. It remains unclear how this strategy stacks up to serial spot treatments with SBRT to each nodal recurrence, as is formally being evaluated on the PEACE V-STORM trial.
TBL:Many men with isolated pelvic nodal recurrence after prior definitive therapy to the prostate will remain without extra-pelvic disease at 5 years following salvage radiation. | Vaugier, Eur Urol 2024
The Study: This scenario largely captures what is meant by the art of oncology with a wide array of options that fall all along the aggressiveness spectrum. The single-arm phase 2 OLIGOPELVIS (GETUG-P07) trial delivered 6 months of ADT with salvage radiation of 54 Gy in 28 fractions to standard pelvic nodal volumes for 67 men with isolated recurrence in ≤5 pelvic nodes per fluorocholine PET restaging upon biochemical recurrence after prior definitive treatment: 37 were s/p definitive surgery or prostate-alone radiation and 30 were s/p surgery and salvage prostate bed-alone radiation. Importantly, these were largely aggressive biochemical recurrences with a median PSA doubling time of 4–5 months and a median absolute PSA level of 3-4. Median time to next biochemical recurrence was 2.2 years, and late toxicity was <5%. Five-year outcomes are now available and demonstrate one-third of patients remain without biochemical recurrence at five years. What’s more, subsequent nodal failure occurred in 14 (21%): 4 developed after receiving 54 Gy, 5 after failing to receive 54 Gy when they should have per RTOG volumes, and 8 outside standard volumes (think inguinal but mostly para-aortic nodes). Another 7 (10%) developed subsequent prostate bed failure, all of which had received at least 54 Gy. It remains unclear how this strategy stacks up to serial spot treatments with SBRT to each nodal recurrence, as is formally being evaluated on the PEACE V-STORM trial.
TBL:Many men with isolated pelvic nodal recurrence after prior definitive therapy to the prostate will remain without extra-pelvic disease at 5 years following salvage radiation. | Vaugier, Eur Urol 2024