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

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Klinik und Poliklinik für Nuklearmedizin (Prof. Weber)

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Document type:: Journal Article
Author(s):: 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
Title:: 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.
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.
Journal title abbreviation:: World J Urol
Year:: 2023
Journal volume:: 41
Journal issue:: 9
Pages contribution:: 2343-2350
Fulltext / DOI:: doi:10.1007/s00345-023-04534-5
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/37515651
Print-ISSN:: 0724-4983
TUM Institution:: Klinik und Poliklinik für Nuklearmedizin (Prof. Weber)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Nuklearmedizin (Prof. Weber)2023