Long-term Outcomes of Salvage Lymph Node Dissection for Nodal Recurrence of Prostate Cancer After Radical Prostatectomy: Not as Good as Previously Thought

Bravi, Carlo Andrea; Fossati, Nicola; Gandaglia, Giorgio; Suardi, Nazareno; Mazzone, Elio; Robesti, Daniele; Osmonov, Daniar; Juenemann, Klaus‐Peter; Boeri, Luca; Karnes, R. Jeffrey; Kretschmer, Alexander; Büchner, Alexander; Stief, Christian G.; Hiester, Andreas; Nini, Alessandro; Albers, Peter; Devos, Gaëtan; Joniau, Steven; Poppel, Hendrik Van; Shariat, Shahrokh F.; Heidenreich, Axel; Pfister, David; Tilki, Derya; Graefen, Markus; Gill, Inderbir S.; Mottrie, Alexander; Karakiewicz, Pierre I.; Montorsi, Francesco; Briganti, Alberto

doi:10.1016/j.eururo.2020.06.043

Cited by 90 publications

(65 citation statements)

References 35 publications

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“…STOMP trial: median 21 months; 80% C.I. 14-29 months) but can be related to the shorter follow-up time of our study (10.6 months (range 8.3 -21 months) (4,9,38).…”

Section: Discussionmentioning

confidence: 72%

Lutetium-177-PSMA-617 in Low-Volume Hormone-Sensitive Metastatic Prostate Cancer: A Prospective Pilot Study

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Peters

Muselaers

et al. 2021

Clinical Cancer Research

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“…STOMP trial: median 21 months; 80% C.I. 14-29 months) but can be related to the shorter follow-up time of our study (10.6 months (range 8.3 -21 months) (4,9,38).…”

Section: Discussionmentioning

confidence: 72%

Lutetium-177-PSMA-617 in Low-Volume Hormone-Sensitive Metastatic Prostate Cancer: A Prospective Pilot Study

Privé

Peters

Muselaers

et al. 2021

Clinical Cancer Research

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“…This difference is explained by the fact that most patients (66%) in the Suardi study received long-term ADT, which contributed to the postponement of clinical recurrence. Bravi et al reported long-term outcomes (median follow-up greater than 7 years) of 189 oligorecurrent PCa patients treated with sLND at 11 tertiary referral centers [ 25 ]. Median clinical recurrence-free survival was superior to our cohort (median 63 months vs. 30 months, respectively).…”

Section: Discussionmentioning

confidence: 99%

Oncological Outcomes of Metastasis-Directed Therapy in Oligorecurrent Prostate Cancer Patients Following Radical Prostatectomy

Devos

Berghen

Eecke

et al. 2020

Cancers

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Several retrospective and a few prospective studies have shown that metastasis-directed therapy (MDT) could delay clinical progression and postpone the initiation of systemic treatment in oligorecurrent prostate cancer (PCa) patients. However, these endpoints are strongly influenced by variables such as concomitant use of androgen deprivation therapy (ADT) and follow-up imaging protocols. The aim of this manuscript was to assess palliative ADT- and metastatic castration-resistant prostate cancer (mCRPC)-free survival as long-term oncological outcomes in oligorecurrent PCa treated by MDT. We retrospectively identified consecutive post-prostatectomy oligorecurrent PCa patients treated by MDT (salvage lymphadenectomy, radiotherapy, or metastasectomy) at our tertiary referral center. Patients were eligible for inclusion if they developed recurrence following radical prostatectomy, had ≤5 metastatic lesions on imaging and had a serum testosterone >50 ng/dL or a testosterone suppression therapy-free interval of >2 years prior to the first MDT as an assumption of recovered serum testosterone (if no testosterone measurement available). Patients with castration-resistant or synchronous oligometastatic PCa at the time of first MDT were excluded. Repeated MDTs were allowed, as well as a period of concomitant ADT. Kaplan–Meier analyses were performed to assess palliative ADT-free and mCRPC-free survival. We identified 191 eligible patients who underwent MDT. Median follow-up from first MDT until last follow-up or death was 45 months (IQR 27–70; mean 51 months). Estimated median palliative-ADT free survival was 66 months (95% CI 58–164) and estimated median mCRPC-free survival was not reached (mean 117 months, 95% CI 103–132). In total, 314 MDTs were performed and 25 patients (13%) received ≥3 MDTs. This study demonstrated that (repeated) MDT is feasible and holds promise in terms of palliative ADT-free and mCRPC-free survival for patients with oligorecurrent PCa. However, these findings should be confirmed in prospective randomized controlled trials.

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“…Additionally, sLND is technically challenging with a risk of significant complications requiring surgical management ( 41 ). Given the lack of durable response, technical difficulty and risk of morbidity from sLND, it continues to be recommended only on an experimental basis for a highly selective cohort of patients who are most likely to benefit from the procedure and high-level evidence is still missing to draw any clinically meaningful conclusion about the oncological impact of salvage lymph node dissection on long-term outcomes ( 36 , 42 ).…”

Section: Salvage Lymph Node Dissectionmentioning

confidence: 99%

Rationale for Involved Field Stereotactic Body Radiation Therapy-Enhanced Intermittent Androgen Deprivation Therapy in Hormone-Sensitive Nodal Oligo-Recurrent Prostate Cancer Following Prostate Stereotactic Body Radiation Therapy

et al. 2021

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Lymph node recurrent prostate cancer is a common clinical scenario that is likely to increase significantly with the widespread adoption of novel positron emission tomography (PET) agents. Despite increasing evidence that localized therapy is disease modifying, most men with lymph node recurrent prostate cancer receive only systemic therapy with androgen deprivation therapy (ADT). For men who receive localized therapy the intent is often to delay receipt of systemic therapy. Little evidence exists on the optimal combination of local and systemic therapy in this patient population. In this hypothesis generating review, we will outline the rationale and propose a framework for combining involved field SBRT with risk adapted intermittent ADT for hormone sensitive nodal recurrent prostate cancer. In patients with a limited number of nodal metastases, involved field stereotactic body radiation therapy (SBRT) may have a role in eliminating castrate-resistant clones and possibly prolonging the response to intermittent ADT. We hypothesize that in a small percentage of patients, such a treatment approach may lead to long term remission or cure.

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Long-term Outcomes of Salvage Lymph Node Dissection for Nodal Recurrence of Prostate Cancer After Radical Prostatectomy: Not as Good as Previously Thought

Cited by 90 publications

References 35 publications

Lutetium-177-PSMA-617 in Low-Volume Hormone-Sensitive Metastatic Prostate Cancer: A Prospective Pilot Study

Lutetium-177-PSMA-617 in Low-Volume Hormone-Sensitive Metastatic Prostate Cancer: A Prospective Pilot Study

Oncological Outcomes of Metastasis-Directed Therapy in Oligorecurrent Prostate Cancer Patients Following Radical Prostatectomy

Rationale for Involved Field Stereotactic Body Radiation Therapy-Enhanced Intermittent Androgen Deprivation Therapy in Hormone-Sensitive Nodal Oligo-Recurrent Prostate Cancer Following Prostate Stereotactic Body Radiation Therapy

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