When I had my prostate cancer recurrence it was characterized by a PSA in the mid 80s and a few positive lymph nodes showing on scans. My situation (oligo-recurrent prostate cancer) was described in a recent literature review called Salvage Therapy of Small Volume Prostate Cancer Nodal Failures: A Review of the Literature.
The review indicated that the therapeutic approach to the treatment of nodal oligo-recurrent prostate cancer still remains an object of debate with no firm therapeutic conclusions among clinicians. For the most part it is agreed that hormonal therapies (ADT) should be considered the standard of care.
In some situations, along with ADT surgery could be a therapeutic option, but the balance between benefits and potential severe side effects should be strictly considered. In the alternative, radiotherapy and, in particular, SBRT, seems to be a viable therapeutic option in this clinical setting. However, the reality is that there are very few published experiences to provide a clear road map for the best treatment.
The correct selection of which men should receive which treatment is crucial in this clinical scenario, in order to identify patients that would really benefit of a local approach in a context of potentially disseminated disease. Moreover, the optimal combination of local therapies with systemic treatments remains to be prospectively investigated.
Salvage Therapy of Small Volume Prostate Cancer Nodal Failures: A review of the lLterature; Berardino, DaBari, etal.