Early prostate cancer recurrence with PSMA PET positive unilateral pelvic lesion(s): is one‐sided salvage extended lymph node dissection enough? (ProSTone, NCT04271579)

2021 ◽  
Author(s):  
Sophie Knipper ◽  
Derya Tilki ◽  
Markus Graefen ◽  
Tobias Maurer
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
Lymph Node Dissection ◽  
Cancer Recurrence ◽  
Node Dissection ◽  
Extended Lymph Node Dissection ◽  
Early Prostate Cancer ◽  
Psma Pet ◽  
Prostate Cancer Recurrence

The role of salvage extended lymph node dissection (LND) in patients with rising PSA and PET/CT scan detected nodal recurrence of prostate cancer.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 242-242 ◽  
Author(s):  
Daniel Porres ◽  
Daniar Osmonov ◽  
Alexey Aksenov ◽  
Andrea Katharina Thissen ◽  
Timur H. Kuru ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
Ct Scan ◽  
Lymph Node Dissection ◽  
Local Therapy ◽  
Node Dissection ◽  
Extended Lymph Node Dissection ◽  
Nodal Recurrence ◽  
Pet Ct ◽  
Pet Ct Scan

242 Background: According to the risk constellation recurrence rate of prostate cancer following local therapy is up to 60%. Early salvage radiotherapy already showed a benefit in progression-free survival. We analyzed the impact of salvage extended lymph node dissection on cancer control in patients with rising PSA and nodal recurrence in PET/CT scan. Methods: Between 2003 and 2015 we performed a salvage extended lymph node dissection in 95 patients with rising PSA and nodal recurrence in PET/CT scan after previous local therapy for prostate cancer. The extent of resection field was adjusted to the pre-operative imaging. Results: We identified 95 patients with rising PSA and nodal recurrence in PET/CT scan with a mean age of 66 years (55-76 years). There were no significant intraoperative complications. Postoperatively, 12% had Clavien/Dindo grade 3 complications. Complete PSA response, defined as a postoperative PSA level < 0.2 ng/ml, was diagnosed in 36% of patients. With a median follow-up of 19 months (1-101 months) cancer-specific mortality rate was less than 1%. Median progression-free survival was 7 months (1-43 months). The interval until the initiation of systemic treatment was 12 months (1-43 months). Conclusions: Salvage LND can be performed without significant complications. Immediate complete PSA response can be achieved in one third of patients and systemic therapy can be delayed by one year. For a general treatment recommendation individual predictive markers are currently still missing.

The impact of extended lymph node dissection versus neoadjuvant therapy with limited lymph node dissection on biochemical recurrence in high-risk prostate cancer patients treated with radical prostatectomy: A multi-institutional analysis.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. e543-e543
Author(s):  
Takuya Koie ◽  
Teppei Ookubo ◽  
Koji Mitsuzuka ◽  
Shintaro Narita ◽  
Takamitsu Inoue ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Neoadjuvant Therapy ◽  
Lymph Node Dissection ◽  
Biochemical Recurrence ◽  
Node Dissection ◽  
Extended Lymph Node Dissection ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

e543 Background: The optimal treatment for high-risk prostate cancer (Pca) remains to be established. We previously reported favorable biochemical recurrence-free survival (BRFS) in high-risk Pca patients treated with neoadjuvant therapy comprising a luteinizing-hormone-releasing hormone (LHRH) agonist plus low-dose estramustine phosphate (EMP) (LHRH+EMP) followed by radical prostatectomy (RP). The aim of this study was to assess whether neoadjuvant LHRH+EMP confers an oncological benefit for high-risk Pca compared to extended lymph node dissection (e-PLND). Methods: The Michinoku Urological Cancer Study Group database contained the data of 2403 consecutive Pca patients treated with RP at 4 institutes between March 2000 and December 2014. In the e-PLND group, we identified 238 high-risk Pca patients who underwent RP and e-PLND, with lymphatic tissue removal around the obturator and the external iliac regions, and hypogastric lymph node dissection. The neoadjuvant therapy with limited PLND (l-PLND) group included 280 high-risk Pca patients who underwent RP and removal of the obturator node chain between September 2005 and June 2014 at Hirosaki University. The neoadjuvant LHRH+EMP therapy included the administration of 280 mg/day of LHRH and EMP for 6 months before RP. The outcome measure was BRFS. Results: The 5-year BRFS rates for the neoadjuvant therapy with l-PLND group and e-PLND group were 84.9% and 54.7%, respectively ( P < 0.0001). The operative time was significantly longer in the e-PLND group compared to that of the neoadjuvant therapy with l-PLND group. Grade 3/4 surgery-related complications were not identified in both groups. Conclusions: Although the present study was not randomized, neoadjuvant LHRH+EMP therapy followed by RP might reduce the risk of biochemical recurrence.

Clinical experience with extended lymph node dissection during radical prostatectomy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14545-14545
Author(s):  
G. Sonpavde ◽  
K. Slawin ◽  
J. M. Levitt ◽  
L. Guariguata
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
Radical Prostatectomy ◽  
Lymph Node Dissection ◽  
Regional Lymph Node ◽  
Adjuvant Radiation ◽  
Node Dissection ◽  
Extended Lymph Node Dissection ◽  
Open Radical Prostatectomy

14545 Background: The value of the extent of lymph node dissection at radical prostatectomy remains controversial. We report our experience with extended lymph node dissection in patients undergoing open radical prostatectomy. Methods: 201 consecutive patients with cT1c-cT3a prostate cancer who underwent open radical prostatectomy with an extended regional lymph node (LN) dissection of up to six packets (iliac, hypogastric, and obturator; right and left) by a single surgeon at The Methodist Hospital between July 2002 and April 2004 were studied. No patient was treated with adjuvant radiation or hormonal therapy before elevated PSA levels were observed. Ultrasensitive PSA (uPSA) using the 3rd generation Immulite assay (DPC) was performed periodically beginning at 6 weeks post operatively. A uPSA level ≥ 0.03 ng/mL and rising on at least one subsequent uPSA obtained at least six weeks later was classified as a biochemical recurrence (BCR). Results: The mean patient age was 59 years at the time of surgery (median, 59; range, 39 to 73 years). Median follow-up after surgery was 21 months (range 1–37 months). Gleason Score was ≤ 6, 7, and 8–10 in 37%, 53% and 10% of patients, respectively. Sixty-two patients had extra prostatic extension and 16 patients had seminal vesicle involvement. A total of 3125 pelvic lymph nodes were removed (per patient: mean, 15.64; median, 15; range 4–42). Of these 22 LN (0.71%) were positive in 11 (5.5%) patients. By specified region, 2/1775 (0.23%) of iliac nodes, 6/642 (0.93%) of hypogastric nodes and 9/708 (1.27%) of obturator nodes were positive. Of the 11 patients with positive LN, 3/11 (27.27%) had positive iliac nodes, 6/11 (54.54%) had positive hypogastric nodes, and 6/11 (54.54%) had positive obturator nodes. Using a very stringent definition of BCR in order to compensate for the relatively short follow-up period, the 2 year progression-free survival (PFS) for patients with at least one positive LN was 37.5%. Conclusions: Extended LN dissection may alter the biology of early nodal metastatic prostate cancer and lead to longterm PFS without additional therapy. A higher percentage of patients and nodes are positive in the hypogastric and obturator regions, supporting the rationale to include these with the iliac nodes when performing LN dissection. No significant financial relationships to disclose.

Is there an additional benefit of Tc-99m-PSMA-guided gamma probe use for salvage lymph node dissection in recurrent prostate cancer.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. e591-e591 ◽  
Author(s):  
David Pfister ◽  
Matthias Schmidt ◽  
Friederike Haidl ◽  
Daniel Porres-Knoblauch ◽  
Alexander Drzezga ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Gamma Probe ◽  
Recurrent Prostate Cancer ◽  
Node Dissection ◽  
Psma Pet ◽  
Pet Ct ◽  
Salvage Lymph Node Dissection

e591 Background: PSMA-PET/CT is the most sensitive diagnostic tool in biochemical recurrent prostate cancer to detect minimal metastatic disease. However, it may be difficult to localize small PSMA-positive lymph nodes intraoperatively. Therefore, it was the aim to investigate whether preoperative Tc-99m-PSMA targeting may improve intraoperative tumor localization by use of a gamma probe. Methods: In 13 Patients Ga-68-PSMA-PET/CT identified iliac lymph nodes in patients suitable for salvage lymph node dissection. On the day before operation a mean activity of 480 MBq Tc-99m-PSMA was injected and gamma camera scintigraphy + SPECT was performed 4-5 hours after tracer application. About 24 hours after tracer application a salvage lymph node dissection was performed on the side of initial suspicious lymph node metastases. Sensitivity, specifity, pos and neg. predictive values were calulated for PSMA-PET/CT and gamma probe use to analyse the additional use. Results: In 9 / 13 patients PSMA-positive metastatic lymph nodes were identified in Ga-68 PSMA-PET/CT. A total of 156 lymph nodes were removed with 14 lymph nodes in 9 patients being positive in histopathologic examination. Sensitivity, specifity, pos and neg. predictive values for PSMA PET/CT and gamma probe were 85% and 79%, 99% and 100%, 85% and 100% and 99% and 98% respectively. In one patient only gamma probe use identified a pathologic lymph node. Conclusions: Gamma probe guided salvage lymph node dissection in PSA recurrent prostate cancer is feasible and had a high concordance with PSMA-PET/CT. However, the additional diagnostic benefit is limited compared to PSMA-PET/CT because in only one patient (7%) a positive lymph node could be identified with the use of the gamma probe outside the standard operative area in salvage lymph node dissection.

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