Please use this identifier to cite or link to this item: doi:10.22028/D291-37743
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Title: Long-term Outcomes of Salvage Lymph Node Dissection for Nodal Recurrence of Prostate Cancer After Radical Prostatectomy : Not as Good as Previously Thought
Author(s): Bravi, Carlo A.
Fossati, Nicola
Gandaglia, Giorgio
Suardi, Nazareno
Mazzone, Elio
Robesti, Daniele
Osmonov, Daniar
Juenemann, Klaus-Peter
Boeri, Luca
Jeffrey Karnes, R.
Kretschmer, Alexander
Buchner, Alexander
Stief, Christian
Hiester, Andreas
Nini, Alessandro
Albers, Peter
Devos, Gaëtan
Joniau, Steven
Van Poppel, Hendrik
Shariat, Shahrokh F.
Heidenreich, Axel
Pfister, David
Tilki, Derya
Graefen, Markus
Gill, Inderbir S.
Mottrie, Alexander
Karakiewicz, Pierre I.
Montorsi, Francesco
Briganti, Alberto
Language: English
Title: European Urology
Volume: 78
Issue: 5
Pages: 661-669
Publisher/Platform: Elsevier
Year of Publication: 2020
Free key words: Prostate cancer
Neoplasm recurrence
Positron emission tomography scan
Metastasis-directed therapy
Salvage lymph node dissection
Androgen deprivation therapy
DDC notations: 610 Medicine and health
Publikation type: Journal Article
Abstract: Background Long-term outcomes of patients treated with salvage lymph node dissection (sLND) for nodal recurrence of prostate cancer (PCa) remain unknown. Objective To investigate long-term oncological outcomes after sLND in a large multi-institutional series. Design, setting, and participants The study included 189 patients who experienced prostate-specific antigen (PSA) rise and nodal-only recurrence after radical prostatectomy (RP) and underwent sLND at 11 tertiary referral centers between 2002 and 2011. Lymph node recurrence was documented by positron emission tomography/computed tomography (PET/CT) scan using either 11C-choline or 68Ga prostate-specific membrane antigen ligand. Outcome measurements and statistical analysis The primary outcome of the study was cancer-specific mortality (CSM). The secondary outcomes were overall mortality, clinical recurrence (CR), biochemical recurrence (BCR), and androgen deprivation therapy (ADT)-free survival after sLND. The probability of freedom from each outcome was calculated using Kaplan-Meier analyses. Cox regression analysis was used to predict the risk of prostate CSM after accounting for several parameters, including the use of additional treatments after sLND. Results and limitations At long term, 110 and 163 patients experienced CR and BCR, respectively, with CR-free and BCR-free survival at 10 yr of 31% and 11%, respectively. After sLND, a total of 145 patients received ADT, with a median time to ADT of 41 mo. At a median (interquartile range) follow-up for survivors of 87 (51, 104) mo, 48 patients died. Of them, 45 died from PCa. The probabilities of freedom from cancer-specific and all-cause death at 10 yr were 66% and 64%, respectively. Similar results were obtained in sensitivity analyses in patients with pelvic-only positive PET/CT scan, as well as after excluding men on ADT at PET/CT scan and patients with PSA level at sLND higher than the 75th percentile. At multivariable analyses, patients who had PSA response after sLND (hazard ratio [HR]: 0.45; p = 0.001), and those receiving ADT within 6 mo from sLND (HR: 0.51; p = 0.010) had lower risk of death from PCa. Conclusions A third of men treated with sLND for PET-detected nodal recurrence of PCa died at long term, with PCa being the main cause of death. Salvage LND alone was associated with durable long-term outcomes in a minority of men who significantly benefited from additional treatments after surgery. Taken together, all these data argue against the use of metastasis-directed therapy alone for patients with node-only recurrent PCa. These men should instead be considered at high risk of systemic dissemination already at the time of sLND. Patient summary We assessed long-term outcomes of patients treated with salvage lymph node dissection (sLND) for node-recurrent prostate cancer (PCa). In contrast with prior evidence, we found that the majority of these men recurred after sLND and eventually died from PCa. A significant survival benefit associated with the administration of androgen deprivation therapy after sLND suggests that sLND should be considered part of a multimodal approach rather than an exclusive treatment strategy.
DOI of the first publication: 10.1016/j.eururo.2020.06.043
URL of the first publication:
Link to this record: urn:nbn:de:bsz:291--ds-377431
ISSN: 0302-2838
Date of registration: 27-Oct-2022
Faculty: M - Medizinische Fakultät
Department: M - Urologie und Kinderurologie
Professorship: M - Prof. Dr. Michael Stöckle
Collections:SciDok - Der Wissenschaftsserver der Universität des Saarlandes

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