Salvage Lymph Node Dissection with Adjuvant Radiotherapy for Nodal Recurrence of Prostate Cancer

Jilg, Cordula A.; Rischke, Hans Christian; Reske, Sven N.; Henne, Karl; Grosu, Anca‐Ligia; Weber, Wolfgang; Drendel, Vanessa; Schwardt, Malte; Jandausch, Anett; Schultze-Seemann, Wolfgang

doi:10.1016/j.juro.2012.08.041

Cited by 111 publications

(85 citation statements)

References 29 publications

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“…There is also the option to perform salvage lymph node dissection of the pelvis with (25,26) or without (27,28) adjuvant radiotherapy, taking into account that adjuvant irradiation results in delayed relapse within the treated region, but has no effect on the relapse pattern outside the treated region. Therefore, the combination of two local treatment modalities within the same anatomic region does not offer any additional benefit for patients with prostate cancer (27).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the combination of two local treatment modalities within the same anatomic region does not offer any additional benefit for patients with prostate cancer (27). In addition, surgery has the risk of common perioperative complications (25)(26)(27)(28). To our knowledge, no prospective studies comparing salvage lymph node dissection with or without radiotherapy using PSMA-PET/CT for staging purposes have been conducted.…”

Section: Discussionmentioning

confidence: 99%

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68Ga-PSMA Ligand PET/CT-based Radiotherapy for Lymph Node Relapse of Prostate Cancer After Primary Therapy Delays Initiation of Systemic Therapy

Henkenberens

Klot

Roß

et al. 2017

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Among patients with prostate cancer, tumor relapse after primary therapy particularly occurs in high-risk groups. The standard of care for distant relapse of prostate cancer is androgen-deprivation therapy (ADT), which has a negative impact on the patient's quality of life (1). Recently alternative local treatment strategies have been proposed for patients with oligometastatic disease, who have a better prognosis than patients with extensive disease (2). Local therapies such as radiotherapy could provide effective local control, delay disease progression and therefor reduce the need to initiate systemic therapies (3). The identification of patients with oligometastatic prostate cancer is challenging due to the lack of sufficiently sensitive imaging for detection of low-volume recurrent and metastatic disease in patients with low prostatespecific antigen (PSA) levels (2). In general, positronemission tomography-computed tomography (PET/CT) for radiotherapy has proven helpful in patient selection and target volume delineation, with promising results regarding clinical outcome and toxicity (4, 5). A new diagnostic option in this context is the use of prostate-specific membrane antigen (PSMA) ligands for PET/CT. 68 Ga-PSMA ligand PET/CT has been reported to have a substantially higher diagnostic accuracy for the detection of prostate cancer metastases than choline-based PET/CT, particularly in the case of lymph node metastases (6-10). Data on the effectiveness of 68 Ga-PSMA ligand PET/CT-based radiotherapy for prostate cancer lymph node metastases after primary therapy are limited.The aim of the present study was to assess the clinical outcome and time of initiation of systemic therapies (ADT or chemotherapy) of patients with isolated prostate cancer lymph node metastases after primary therapy treated with 68 Ga-labelled PSMA ligand PET/CT-guided 3D conformal radiotherapy. Patients and MethodsStudy population. Between June 2014 and March 2016, 23 patients with biochemical failure and a PSA above 0.5 ng/ml after primary therapy of prostate cancer underwent 68 Ga-PSMA ligand PET/CT for restaging purposes and were treated with radiotherapy of the 68 Ga-PSMA ligand PET/CT-positive lymph nodes. All cases were discussed 1273

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

68Ga-PSMA Ligand PET/CT-based Radiotherapy for Lymph Node Relapse of Prostate Cancer After Primary Therapy Delays Initiation of Systemic Therapy

Henkenberens

Klot

Roß

et al. 2017

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“…Impressively, the 8-year cancer-specific mortality-free survival and biochemical recurrence-free rates were 81 and 23%, respectively. Similarly, a German group found that 46% experienced complete biochemical response after salvage pelvic lymph node dissection [26]. Just under half of this cohort received adjuvant radiotherapy following lymph node dissection but this subset of men did not exhibit an advantage in preventing clinical progression.…”

Section: Superior Detection Of Bone Metastasesmentioning

confidence: 95%

The phytological future of prostate cancer staging: PSMA-PET and the dandelion theory

et al. 2017

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Keywords• metastasis • PET • prostate cancer • PSMA • staging Anybody who has spent more than a few hours cutting or rolling a newly laid lawn will be familiar with the blight of dandelions. Catch one before it is seeded and your lawn stands a chance of retaining its pristine lines and surface (Figure 1). But come out one windy evening to find a freshly seeded flower head and all is lost. Even if you pluck it out you can be certain that the tiny seed pods have been carried to all four corners of your lawn and, given a month, will make their presence known. So much for gardening, but cancer surgery is often similar.One of the core principles of radical surgery is accurate staging in the preoperative setting. For most cancers, it is essential to confirm that the tumor is localized -that is, has not yet seeded -such that radical resection can reasonably be expected to achieve a cure [1]. In prostate cancer, various imaging methods have been employed to provide this information, with European Guidelines currently recommending MRI for local staging and CT/bone scan for exclusion of distant metastases for those with intermediate or high-risk disease [2]. However, it is generally accepted that CT/bone scan has low sensitivity and specificity for detection of metastatic disease, with small foci often missed, or conversely nonspecific lesions being detected such as degenerative bone disease or reactive inflammatory changes in the lymph nodes. This being the case, many men with 'localized disease' deemed to be candidates for radical surgery over the past few decades are likely, in fact, to have had small volume or micrometastatic disease. Although it is hard to tease out which subset of men undergoing surgery are in this group, they form part of a cohort in whom we have seen excellent oncological PSMA-PET is changing how we stage prostate cancer, both in the primary setting and with relapse after treatment. It allows us to identify lesions in the bones and lymph nodes that were not previously visible on conventional imaging with bone scan and CT/MRI. In this Special Report we review the 'state of the art' for PSMA imaging and discuss the implications for treatment decisions in prostate cancer. We liken early high risk or metastatic prostate to a common phytological problem: the dandelion. In this analogous situation, we consider the additional evidence needed for us to start plucking out the original dandelion and for us to focus attention on killing the seeded weeds that are identifiable elsewhere in the lawn.

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“…A. Jilg и соавт. оценили данные 52 пациентов, которым провели первичное лечение по поводу РПЖ [27]. У всех больных зарегистрирован биохимический рецидив и выявлены метастатические очаги в ЛУ по данным ПЭТ / КТ, а также подтверждено отсутствие отдаленных метастазов.…”

Section: диагностика и лечение опухолей мочеполовой системы рак предunclassified

Methods for the diagnosis and treatment of oligometastases in patients with prostate cancer and progressive disease after radical treatment

Алексеев¹,

Нюшко²,

Krasheninnikov³

et al. 2016

Cancer Urology

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Salvage Lymph Node Dissection with Adjuvant Radiotherapy for Nodal Recurrence of Prostate Cancer

Cited by 111 publications

References 29 publications

68Ga-PSMA Ligand PET/CT-based Radiotherapy for Lymph Node Relapse of Prostate Cancer After Primary Therapy Delays Initiation of Systemic Therapy

68Ga-PSMA Ligand PET/CT-based Radiotherapy for Lymph Node Relapse of Prostate Cancer After Primary Therapy Delays Initiation of Systemic Therapy

The phytological future of prostate cancer staging: PSMA-PET and the dandelion theory

Methods for the diagnosis and treatment of oligometastases in patients with prostate cancer and progressive disease after radical treatment

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