Node Oligorecurrence in Prostate Cancer: A Challenge

SIMPLE SUMMARY: Nodal oligorecurrence in prostate cancer is currently a topic of extensive research mainly due to its indolent spread pattern and to the remarkable advancements in molecular imaging methods like PSMA-PET. These innovative techniques can identify cancer at lower PSA levels compared to traditional imaging methods. Furthermore, localized ablative radiotherapy treatments like stereotactic body radiotherapy (SBRT) are now accessible, offering enhanced local control and minimal adverse effects. As a result, metastasis-directed therapy with SBRT is becoming an increasingly attractive treatment option for these patients. Despite these advancements, there are still many uncertainties that require further investigation. This review aims to summarize the data supporting this approach, discuss controversies concerning the selection of patients and the best treatment approach, and explore ongoing phase III trials and the future of treating nodal recurrence in prostate cancer. ABSTRACT: Within the oligometastatic state, oligorecurrent lymph node disease in prostate cancer represents an interesting clinical entity characterized by a relatively indolent biology that makes it unique: it can be treated radically, and its treatment is usually associated with a long period of control and excellent survival. Additionally, it is an emergent situation that we are facing more frequently mainly due to (a) the incorporation into clinical practice of the PSMA-PET that provides strikingly increased superior images in comparison to conventional imaging, with higher sensitivity and specificity; (b) the higher detection rates of bone and node disease with extremely low levels of PSA; and (c) the availability of high-precision technology in radiotherapy treatments with the incorporation of stereotaxic body radiotherapy (SBRT) or stereotaxic ablative radiotherapy (SABR) technology that allows the safe administration of high doses of radiation in a very limited number of fractions with low toxicity and excellent tolerance. This approach of new image-guided patient management is compelling for doctors and patients since it can potentially contribute to improving the clinical outcome. In this work, we discuss the available evidence, areas of debate, and potential future directions concerning the utilization of new imaging-guided SBRT for the treatment of nodal recurrence in prostate cancer.