Metastasis-directed therapy is a feasible option for low PSA, recurrent locoregional metastatic prostate cancer. After initial salvage surgery, patients with good response might consider a repeat salvage surgery in case of recurrent, isolated, and PSMA-positive metastases.
This analysis aimed to evaluate the oncological outcome and safety of repeat PSMA-targeted radioguided surgery (RGS) after either prior RGS or "standard" salvage lymph node dissection (SLND).
We identified 37 patients undergoing repeat RGS after prior SLND (n = 21) (SLND-RGS) or prior RGS (n = 16) (RGS-RGS) between 2014 and 2021 after initial radical prostatectomy with or without pelvic radiation therapy at two German tertiary referral centers. Kaplan-Meier analyses and uni-/multivariable Cox regression models were used to investigate factors associated with biochemical recurrence-free survival (BRFS) and treatment-free survival (TFS) after repeat salvage surgery.
Complete Biochemical Response (cBR, PSA < 0.2 ng/ml) was observed in 20/32 patients (5 NA). Median overall BRFS [95% confidence interval (CI)] after repeat salvage surgery was 10.8 months (mo) (5.3-22). On multivariable regression, only age (HR 1.09, 95% CI 1.01-1.17) and preoperative PSA (HR 1.23, 95% CI 1.01-1.50) were associated with shorter BRFS, although PSA (HR 1.16, 95% CI 0.99-1.36) did not achieve significant predictor status in univariable analysis before (p value = 0.07). Overall, one year after second salvage surgery, 89% of the patients (number at risk: 19) did not receive additional treatment and median TFS was not reached. Clavien-Dindo grade > 3a complications were observed in 8% (3/37 patients). Limitations are the retrospective evaluation, heterogeneous SLND procedures, lack of long-term follow-up data, and small cohort size.
In this study, repeat RGS was safe and provided clinically meaningful biochemical recurrence- and treatment-free intervals for selected cases. Patients having low preoperative PSA seemed to benefit most of repeat RGS, irrespective of prior SLND or RGS or the time from initial RP/first salvage surgery.
World journal of urology. 2023 Jul 29 [Epub ahead of print]
Fabian Falkenbach, Sophie Knipper, Daniel Koehler, Francesca Ambrosini, Thomas Steuber, Markus Graefen, Lars Budäus, Matthias Eiber, Lukas Lunger, Flemming Lischewski, Matthias M Heck, Tobias Maurer
Martini-Klinik Prostate Cancer Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. ., Martini-Klinik Prostate Cancer Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany., Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Department of Nuclear Medicine, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany., Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/37515651