In these patients, PSMA-targeted radioguided surgery (RGS) has been proven effective for removing cancerous tissue leading to consecutive PSA responses. Therefore, salvage lymph node dissection (SLND) utilizing intraoperative guidance by RGS may represent an alternative to surveillance, androgen deprivation therapy, or radiotherapy. In this article, Falkenbach, et al. from the Martini-Klinik Prostate Cancer Center (University of Hamburg-Eppendorf, Germany) investigated whether repeat RGS after prior RGS or SLND without intraoperative RGS is feasible. In their cohort, 20 of 32 patients (5 NA) achieved complete biochemical response (PSA < 0.2 ng/ml) after secondary RGS. The median overall biochemical recurrence-free survival was 10.8 months (95%-CI 5.3–22). One year after the second salvage surgery, 89% of the patients had not received additional treatment. Severe complications were observed in 8% (3/37 patients). The time between the first and second salvage surgery and the initial kind of salvage surgery (RGS vs SLND) did not achieve significant predictor status. Further research is warranted to identify patients who benefit most from surgical metastasis-directed therapy.
To conclude, repeat RGS was safe and provided clinically meaningful short-term biochemical recurrence- and treatment-free intervals for selected cases. Patients having low preoperative PSA benefited most from repeat RGS, irrespective of prior SLND or SLND-RGS or the time from initial RP/first salvage surgery.
Figure: RGS-Measurement during surgery to verify complete cancer removal ex vivo.
Written by: Fabian Falkenbach, MD, Sophie Knipper, MD, & Tobias Maurer, MD, FEBU
Martini-Klinik Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
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