Please use this identifier to cite or link to this item: doi:10.22028/D291-37744
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Title: Assessing the Best Surgical Template at Salvage Pelvic Lymph Node Dissection for Nodal Recurrence of Prostate Cancer After Radical Prostatectomy : When Can Bilateral Dissection be Omitted? Results from a Multi-institutional Series
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: 6
Pages: 779-782
Publisher/Platform: Elsevier
Year of Publication: 2020
Free key words: Prostate cancer
Neoplasm recurrence
1C-choline positron emission tomography scan
68Ga prostate-specific membrane antigen positron emission tomography scan
Metastasis-directed therapy
Salvage lymph node dissection
Surgical template
Unilateral dissection
DDC notations: 610 Medicine and health
Publikation type: Journal Article
Abstract: The best surgical template for salvage pelvic lymph node dissection (sLND) in patients with nodal recurrence from prostate cancer (PCa) after radical prostatectomy (RP) is currently unknown. We analyzed data of 189 patients with a unilateral positive positron emission tomography (PET) scan of the pelvic lymph node areas, who were treated with bilateral pelvic sLND after RP at 11 high-volume centers. The primary endpoint was missed contralateral disease at final pathology, defined as lymph node positive for PCa in the side opposite to the positive spot(s) at the PET scan. Overall, 93 (49%) and 96 (51%) patients received a 11C-choline and a 68Ga prostate-specific membrane antigen (PSMA) PET scan, respectively, and 171 (90%) and 18 (10%) men had one and two positive spots, respectively. The rate of missed contralateral PCa was 18% (34/189), with the rates being 17% (29/171) and 28% (5/18) in men with one and two positive spots, respectively. While the rate of contralateral disease did not differ between 68Ga-PSMA and 11C-choline (29% and 27%, respectively) among men with two positive spots, the rate of contralateral PCa was only 6% with 68Ga-PSMA versus 28% with 11C-choline in patients with a single positive spot. This finding was confirmed at multivariable logistic regression analysis predicting missed disease at final pathology after accounting for confounders (odds ratio: 0.24; p =  0.001). However, in men with a single positive spot at 68Ga-PSMA PET/computed tomography, the rate of single confirmed lymph node metastasis at final pathology was only 33%, suggesting the need for extended template even if unilateral dissection is performed. Awaiting confirmatory studies, patients diagnosed with a single positive spot at the 68Ga-PSMA PET scan might be considered for unilateral extended pelvic sLND. Patient summary We assessed the risk of missing contralateral disease in patients with a positron emission tomography (PET) scan suggestive of unilateral nodal recurrence from prostate cancer (PCa) after radical prostatectomy and who were treated with bilateral salvage lymph node dissection (sLND). Variability exists according to the number of positive spots and PET tracer, with the lowest rate of missed PCa in men diagnosed with a single positive spot at a 68Ga prostate-specific membrane antigen PET scan (6%). If replicated, our data suggest that these patients might be considered for unilateral extended pelvic sLND.
DOI of the first publication: 10.1016/j.eururo.2020.06.047
URL of the first publication:
Link to this record: urn:nbn:de:bsz:291--ds-377445
ISSN: 0302-2838
Date of registration: 27-Oct-2022
Faculty: M - Medizinische Fakultät
Department: M - Urologie und Kinderurologie
Professorship: M - Prof. Dr. Michael Stöckle
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