The future of salvage lymph node dissection in the prostate‐specific membrane antigen era

Bello, Ana Plata; Touijer, Karim

doi:10.1111/bju.15591

Cited by 1 publication

(1 citation statement)

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“…Notably, after SLND, two-thirds of the patients had PET-positive nodal disease, which was already observable on pre-SLND PSMA PET. This challenges the concept of SLND as a monotherapy for oligorecurrent prostate cancer [ 30 , 31 ]. In a recent retrospective analysis comparing PSMA PET-staged unilateral SLND versus SNRT, the biochemical recurrence rate at maximum follow-up was 40.3% (27 patients) for the SNRT cohort and 86.4% (57 patients; p < 0.001) for the SLND cohort [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Salvage Nodal Radiotherapy as Metastasis-Directed Therapy for Oligorecurrent Prostate Cancer Detected by Positron Emission Tomography Shows Favorable Outcome in Long-Term Follow-Up

Tamihardja

Zehner

Hartrampf

et al. 2022

Cancers

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Background: The study aimed to access the long-term outcome of salvage nodal radiotherapy (SNRT) in oligorecurrent prostate cancer. Methods: A total of 95 consecutive patients received SNRT for pelvic and/or extrapelvic nodal recurrence after prostate-specific membrane antigen (PSMA) or choline PET from 2010 to 2021. SNRT was applied as external beam radiotherapy with simultaneous integrated boost up to a median total dose of 62.9 Gy (EQD21.5Gy) to the recurrent lymph node metastases. The outcome was analyzed by cumulative incidence functions with death as the competing risk. Fine–Gray regression analyses were performed to estimate the relative hazards of the outcome parameters. Genitourinary (GU)/gastrointestinal (GI) toxicity evaluation utilized Common Toxicity Criteria for Adverse Events (v5.0). The results are as follows: the median follow-up was 47.1 months. The five-year biochemical progression rate (95% CI) was 50.1% (35.7–62.9%). Concomitant androgen deprivation therapy (ADT) was adminstered in 60.0% of the patients. The five-year biochemical progression rate was 75.0% (42.0–90.9%) without ADT versus 35.3% (19.6–51.4%) with ADT (p = 0.003). The cumulative five-year late grade 3 GU toxicity rate was 2.1%. No late grade 3 GI toxicity occured. Conclusions: Metastasis-directed therapy through SNRT for PET-staged oligorecurrent prostate cancer demonstrated a favorable long-term oncologic outcome. Omittance of ADT led to an increased biochemical progression.

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Section: Discussionmentioning

confidence: 99%