Volume 73, Issue 2, Pages 156-165 (February 2018) A Systematic Review and Framework for the Use of Hormone Therapy with Salvage Radiation Therapy for Recurrent Prostate Cancer  Daniel E. Spratt, Robert T. Dess, Zachary S. Zumsteg, Daniel W. Lin, Phuoc T. Tran, Todd M. Morgan, Emmanuel S. Antonarakis, Paul L. Nguyen, Charles J. Ryan, Howard M. Sandler, Matthew R. Cooperberg, Edwin Posadas, Felix Y. Feng  European Urology  Volume 73, Issue 2, Pages 156-165 (February 2018) DOI: 10.1016/j.eururo.2017.06.027 Copyright © 2017 European Association of Urology Terms and Conditions

Fig. 1 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. European Urology 2018 73, 156-165DOI: (10.1016/j.eururo.2017.06.027) Copyright © 2017 European Association of Urology Terms and Conditions

Fig. 2 Tumor characteristics of patients enrolled in RTOG 9601 and GETUG-16. Green color represents a favorable prognostic feature and red represents an unfavorable prognostic feature. Areas of shading between green and red are estimates and absolute values were not reported or could not be extracted. For example, in RTOG 9601 12% of patients had persistently positive PSAs of ≥0.5 ng/ml. It is unknown how many had any form of detectable PSA. PSA=prostate-specific antigen; RT=radiotherapy; RTOG=Radiation Therapy Oncology Group. European Urology 2018 73, 156-165DOI: (10.1016/j.eururo.2017.06.027) Copyright © 2017 European Association of Urology Terms and Conditions

Fig. 3 Kaplan–Meier curves of biochemical control for patients treated with GETUG-16. Red dotted line is the salvage radiotherapy with 6 mo of an LHRH agonist arm, and the blue dotted line is the salvage radiotherapy–alone arm. The graphical representation shows the intrinsic improvement in biochemical control when testosterone is lowered, which causes a decline in PSA. ADT=androgen deprivation therapy; LHRH=luteinizing hormone–releasing hormone; PSA=prostate-specific antigen; SRT=salvage radiotherapy. European Urology 2018 73, 156-165DOI: (10.1016/j.eururo.2017.06.027) Copyright © 2017 European Association of Urology Terms and Conditions

Fig. 4 Comparing and contrasting a prognostic biomarker to guide hormone therapy use with salvage radiotherapy (eg, preradiotherapy PSA), and a predictive biomarker that identifies patients who may respond more or less favorably to hormone therapy (eg, the PAM50 classifier). ADT=androgen deprivation therapy; PSA=prostate-specific antigen; RT=radiotherapy. European Urology 2018 73, 156-165DOI: (10.1016/j.eururo.2017.06.027) Copyright © 2017 European Association of Urology Terms and Conditions