Salvage Lymph Node Dissection for Nodal Recurrent Prostate Cancer: A Systematic Review

Ploussard, Guillaume; Gandaglia, Giorgio; Borgmann, Hendrik; Visschere, Pieter De; Heidegger, Isabel; Kretschmer, Alexander; Mathiéu, Romain; Surcel, C.; Tilki, Derya; Tsaur, Igor; Valério, Massimo; Bergh, Roderick van den; Ost, Piet; Briganti, Alberto

doi:10.1016/j.eururo.2018.10.041

Cited by 120 publications

(85 citation statements)

References 35 publications

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“…The majority of our small cohort developed clinical recurrence (14/23) (follow-up was 31.2 ± SD 12.8 months). From our experience [17] and the latest literature (metaanalysis of 27 series), it is known that the 2-and 5-year biochemical progression-free survival rates range from 23 to 64% and from 6 to 31%, respectively; the 5-year overall survival is approximately 84% [18,36]. By rough estimation, our cohort has an outcome which is not better than that of patients treated with conventional salvage LND.…”

Section: Rauscher Et Al Reported On 31 Men Undergoing Rgs With 111mentioning

confidence: 72%

Results from extended lymphadenectomies with [111In]PSMA-617 for intraoperative detection of PSMA-PET/CT-positive nodal metastatic prostate cancer

et al. 2020

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Purpose: Identification of suspicious PSMA-PET/CT-positive lymph node (LN) metastases (LNM) from prostate cancer (PCa) during lymphadenectomy (LA) is challenging. We evaluated an 111 In-labelled PSMA ligand (DKFZ-617, referred to as [ 111 In]PSMA-617) as a γ-emitting tracer for intraoperative γ-probe application for resected tissue samples in PCa patients. Forty-eight hours prior to LA, [ 111 In]PSMA-617 was administered intravenously in 23 patients with suspected LNM on PSMA-PET/CT (n = 21 with biochemical relapse, n = 2 at primary therapy). Resected tissue samples (LN, LNM and fibrofatty tissue) were measured ex situ by a γ-probe expressed as counts per second (CPS norm ). [ 111 In]PSMA-617 tissue sample uptake was measured by a germanium detector for verification and calculated as %IA lbm (percent injected activity per kilogram lean body mass at time of surgery). Based on a clinical requirement for a specificity > 95%, thresholds for both ex situ measurements were chosen accordingly. Correlation of the results from PET/CT, γ-probe and germanium detector with histopathology was done. Results: Eight hundred sixty-four LNs (197 LNM) were removed from 275 subregions in 23 patients, on average 8.6 ± 14.9 LNM per patient. One hundred four of 275 tissue samples showed cancer. Median γ-probe and germanium detector results were significantly different between tumour-affected (33.5 CPS norm , 0.71 %IA lbm ) and tumour-free subregions (3.0 CPS norm , 0.03 %IA lbm ) (each p value < 0.0001). For the chosen γ-probe cut-off (CPS norm > 23) and germanium detector cut-off (%IA lbm > 0.27), 64 and 74 true-positive and 158 true-negative samples for both measurements were identified. Thirty-nine and 30 false-negative and 6 and 5 false-positive tissue samples were identified by γ-probe and germanium detector measurements.Conclusion: [ 111 In]PSMA-617 application for LA is feasible in terms of an intraoperative real-time measurement with a γ-probe for detection of tumour-affected tissue samples. γ-probe results can be confirmed by precise germanium detector measurements and were significantly different between tumour-affected and tumour-free samples.

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Section: Rauscher Et Al Reported On 31 Men Undergoing Rgs With 111mentioning

confidence: 72%

Results from extended lymphadenectomies with [111In]PSMA-617 for intraoperative detection of PSMA-PET/CT-positive nodal metastatic prostate cancer

et al. 2020

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“…Seiler et al [14] showed that a subset (8%) of the 88 patients who had undergone RP and had tumour‐positive ePLND without adjuvant treatment had not experienced BCR at a median follow‐up of 15 years. In a systematic review of oncological outcomes after salvage lymph node dissection, Ploussard et al [15] reported 2‐ and 5‐year BCR‐free survival of 23–64% and 6–31%, respectively, in patients with a tumour‐positive salvage ePLND. These results support early localization of loco‐regional disease recurrence in order to benefit from salvage therapies.…”

Section: Discussionmentioning

confidence: 99%

Distribution of prostate cancer recurrences on gallium‐68 prostate‐specific membrane antigen (⁶⁸Ga‐PSMA) positron‐emission/computed tomography after radical prostatectomy with pathological node‐positive extended lymph node dissection

et al. 2020

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Objectives To examine the anatomical distribution of prostate cancer (PCa) recurrence on gallium‐68 prostate‐specific membrane antigen (68Ga‐PSMA) positron‐emission tomography (PET)/computed tomography (CT) in patients with biochemical recurrence (BCR) after undergoing radical prostatectomy (RP) with pathological lymph node metastasis (pN1) in their extended pelvic lymph node dissection (ePLND), and to compare the location of PCa recurrence with the location of the initial lymph node metastasis at ePLND. Materials and Methods We retrospectively reviewed 100 patients with BCR (PSA 0.05–5.00 ng/mL) after RP with pN1 ePLND who underwent 68Ga‐PSMA PET/CT to guide salvage therapy. Clinical and pathological features and anatomical locations of PCa recurrence on 68Ga‐PSMA PET/CT were obtained, and management impact was recorded. Results In all, 68 patients (68%) had a positive and 32 patients (32%) had a negative 68Ga‐PSMA PET/CT result. Of the 68 patients with a positive 68Ga‐PSMA PET/CT, 44 (65%) showed abnormal uptake only in the pelvic area, seven (10%) only outside the pelvic area, and 17 (25%) both within and outside the pelvic area. 68Ga‐PSMA PET/CT‐positive pelvic lymph nodes were often (84%) detected on the same side as the lymph node metastasis diagnosed at ePLND. Based on the outcomes of the 68Ga‐PSMA PET/CT, change of management was noted in 68% of the patients. Conclusion Recurrence of PCa on 68Ga‐PSMA PET/CT was limited to the pelvis in the majority of patients with BCR after RP with pN1 ePLND. Moreover, recurrence was often detected on the same side as the lymph node metastasis at ePLND. The results confirm the diagnostic value of 68Ga‐PSMA PET/CT in patients with BCR after RP with pN1 ePLND. Prospective studies are needed to support the long‐term benefit of 68Ga‐PSMA PET/CT‐dictated management changes.

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“…Molecular imaging can localize lymph node metastases before surgery and, as such, provide a road map to guide sLND or salvage radiotherapy. Several series based mainly on choline PET have suggested an oncologic benefit in selected patients (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). The increasing implementation of sLND has raised intense discussions on the extent of the template that should be treated locally.…”

Section: Psma-guided Surgery As Molecularly Targeted Precision Surgerymentioning

confidence: 99%

“…Some authors have even concluded that sLND is not appropriate either to cure disease or even to delay further systemic treatment (55). These seemingly contradictory results might be due to patient characteristics causing a different likelihood of harboring systemic disease (23). To estimate the risk and to counsel patients about sLND or salvage radiotherapy, several clinical variables can be considered in addition to the findings of PSMA-ligand PET imaging.…”

Section: Comparison Of Psma-guided Slnd To Standard Approachesmentioning

confidence: 99%

“…Still, emerging data seem to hint at the superiority of PSMA-radioguided salvage surgery over standard sLND (59). The main drawbacks for analysis and comparisons of sLND series are not only the differences in study populations and the lack of long-term follow-up in most studies but also the differences in evaluated endpoints or definitions of progression (23).…”

Section: Comparison Of Psma-guided Slnd To Standard Approachesmentioning

confidence: 99%

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Prostate-Specific Membrane Antigen–Guided Surgery

et al. 2019

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Since its introduction to the diagnostic pathway for prostate cancer management, prostate-specific membrane antigen (PSMA)-ligand PET has demonstrated great potential. PSMA-ligand imaging is increasingly influencing therapeutic decision making, although its impact on patient outcomes still needs to be defined. One relatively new application, enabled through chemical and engineering efforts, is PSMA-guided surgery. This review highlights the potential of PSMA-guided surgery and discusses its implications in lymph node dissection in primary and recurrent prostate cancer.

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Salvage Lymph Node Dissection for Nodal Recurrent Prostate Cancer: A Systematic Review

Cited by 120 publications

References 35 publications

Results from extended lymphadenectomies with [111In]PSMA-617 for intraoperative detection of PSMA-PET/CT-positive nodal metastatic prostate cancer

Results from extended lymphadenectomies with [111In]PSMA-617 for intraoperative detection of PSMA-PET/CT-positive nodal metastatic prostate cancer

Distribution of prostate cancer recurrences on gallium‐68 prostate‐specific membrane antigen (⁶⁸Ga‐PSMA) positron‐emission/computed tomography after radical prostatectomy with pathological node‐positive extended lymph node dissection

Prostate-Specific Membrane Antigen–Guided Surgery

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Salvage Lymph Node Dissection for Nodal Recurrent Prostate Cancer: A Systematic Review

Cited by 120 publications

References 35 publications

Results from extended lymphadenectomies with [111In]PSMA-617 for intraoperative detection of PSMA-PET/CT-positive nodal metastatic prostate cancer

Results from extended lymphadenectomies with [111In]PSMA-617 for intraoperative detection of PSMA-PET/CT-positive nodal metastatic prostate cancer

Distribution of prostate cancer recurrences on gallium‐68 prostate‐specific membrane antigen (68Ga‐PSMA) positron‐emission/computed tomography after radical prostatectomy with pathological node‐positive extended lymph node dissection

Prostate-Specific Membrane Antigen–Guided Surgery

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Distribution of prostate cancer recurrences on gallium‐68 prostate‐specific membrane antigen (⁶⁸Ga‐PSMA) positron‐emission/computed tomography after radical prostatectomy with pathological node‐positive extended lymph node dissection