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EAU 2017

EAU 2017: What is the optimal post-operative management of men with lymph node recurrent prostate cancer after salvage lymph node dissection? Results from a large, multi-institutional series

London, England (UroToday.com) In today’s advanced prostate cancer poster session at the 2017 EAU annual meeting, Dr. Briganti and colleagues presented their multi-institutional collaboration of men experiencing nodal recurrence after radical prostatectomy. Certainly, with continued improvement in imaging modalities, there is increasing interest in salvage surgery for isolated recurrent disease.

Among eight tertiary referral centers, 117 patients were identified as having nodal recurrence after 11C-choline or PSMA PET/CT scan. All patients subsequently underwent a salvage lymph node dissection (SLND) and were stratified as receiving (i) no additional therapy, (ii) adjuvant hormonal therapy (HT), or (iii) adjuvant HT and radiotherapy (RT). PET/CT imaging most commonly noted 1 positive lymph node (n=64, 55%), with the most common location being the pelvic lymph nodes (n=96, 82%). Presenting with a median PSA of 1.8 ng/mL, all men had pathologic lymph node metastases at SLND. Post-operatively, 45% of men (n=53) underwent adjuvant HT, whereas 23% (n=47) received no additional treatment, and 11% (n=17) received HT + RT. At a median follow-up of 46 months, 28 men (24%) suffered nodal recurrence and 11 men (9%) had bone/visceral metastases. Importantly, there was no difference in 3-year recurrence free survival (range 71-81%, p=0.2) or cancer specific survival (all ≥95%, p=0.5) between the three groups. During follow-up, there were 10 (8.5%) cancer-specific mortalities, with no difference among treatment groups. A limitation of this study is a lack of information regarding time to castration-resistance and/or subsequent systemic therapy.

Although a retrospective study with inherent selection bias, this study suggests that a select subgroup of patients with isolated lymph node metastases may benefit from SLND. With the continued utilization of more specific imaging modalities in this arena (ie. PSMA-PET/CT), clinicians will increasingly be faced with these disease-specific challenges in the future.

Presented by: Alberto Briganti, Department of Urology, Vita-Salute University San Raffaele, Milan, Italy

Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto
Twitter: @zklaassen_md

at the #EAU17 -March 24-28, 2017- London, England