Safety and efficiency of repeat salvage lymph node dissection for recurrence of prostate cancer using PSMA-radioguided surgery (RGS) after prior salvage lymph node dissection with or without initial RGS support.

Falkenbach, Fabian; Knipper, Sophie; Koehler, Daniel; Ambrosini, Francesca; Steuber, Thomas; Graefen, Markus; Budäus, Lars; Eiber, Matthias; Lunger, Lukas; Lischewski, Flemming; Heck, Matthias M; Maurer, Tobias

doi:10.1007/s00345-023-04534-5

2023

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Titel:: Safety and efficiency of repeat salvage lymph node dissection for recurrence of prostate cancer using PSMA-radioguided surgery (RGS) after prior salvage lymph node dissection with or without initial RGS support.
Dokumenttyp:: Journal Article
Autor(en):: Falkenbach, Fabian; Knipper, Sophie; Koehler, Daniel; Ambrosini, Francesca; Steuber, Thomas; Graefen, Markus; Budäus, Lars; Eiber, Matthias; Lunger, Lukas; Lischewski, Flemming; Heck, Matthias M; Maurer, Tobias
Abstract:: BACKGROUND AND OBJECTIVE: Metastasis-directed therapy is a feasible option for low PSA, recurrent locoregional metastatic prostate cancer. After initial salvage surgery, patients with good response might consider a repeat salvage surgery in case of recurrent, isolated, and PSMA-positive metastases. This analysis aimed to evaluate the oncological outcome and safety of repeat PSMA-targeted radioguided surgery (RGS) after either prior RGS or "standard" salvage lymph node dissection (SLND). MATERIALS AND METHODS: We identified 37 patients undergoing repeat RGS after prior SLND (n = 21) (SLND-RGS) or prior RGS (n = 16) (RGS-RGS) between 2014 and 2021 after initial radical prostatectomy with or without pelvic radiation therapy at two German tertiary referral centers. Kaplan-Meier analyses and uni-/multivariable Cox regression models were used to investigate factors associated with biochemical recurrence-free survival (BRFS) and treatment-free survival (TFS) after repeat salvage surgery. RESULTS AND LIMITATIONS: Complete Biochemical Response (cBR, PSA < 0.2 ng/ml) was observed in 20/32 patients (5 NA). Median overall BRFS [95% confidence interval (CI)] after repeat salvage surgery was 10.8 months (mo) (5.3-22). On multivariable regression, only age (HR 1.09, 95% CI 1.01-1.17) and preoperative PSA (HR 1.23, 95% CI 1.01-1.50) were associated with shorter BRFS, although PSA (HR 1.16, 95% CI 0.99-1.36) did not achieve significant predictor status in univariable analysis before (p value = 0.07). Overall, one year after second salvage surgery, 89% of the patients (number at risk: 19) did not receive additional treatment and median TFS was not reached. Clavien-Dindo grade > 3a complications were observed in 8% (3/37 patients). Limitations are the retrospective evaluation, heterogeneous SLND procedures, lack of long-term follow-up data, and small cohort size. CONCLUSION: In this study, repeat RGS was safe and provided clinically meaningful biochemical recurrence- and treatment-free intervals for selected cases. Patients having low preoperative PSA seemed to benefit most of repeat RGS, irrespective of prior SLND or RGS or the time from initial RP/first salvage surgery.
Zeitschriftentitel:: World J Urol
Jahr:: 2023
Band / Volume:: 41
Heft / Issue:: 9
Seitenangaben Beitrag:: 2343-2350
Volltext / DOI:: doi:10.1007/s00345-023-04534-5
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/37515651
Print-ISSN:: 0724-4983
TUM Einrichtung:: Klinik und Poliklinik für Nuklearmedizin (Prof. Weber); Klinik und Poliklinik für Urologie (Prof. Gschwend)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Urologie (Prof. Gschwend)2023

mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Nuklearmedizin (Prof. Weber)2023