SAN DIEGO, CA USA (UroToday.com) - Investigators presented novel data suggesting that, for some patients with recurrent prostate cancer to the pelvic lymph nodes following prostatectomy, more surgery may help.
Two abstracts presented by a European group of researchers evaluated salvage lymph node dissection in patients with recurrent prostate cancer. One study evaluated patients who have had radical prostatectomy (RP), while another looked at men who had radical prostatectomy (RP) and were already receiving androgen depravation therapy (ADT). The authors tested the hypothesis that a surgical salvage approach might have an impact on cancer control in some highly-selected patients.
All patients had evidence of biochemical recurrence (BCR) after RP associated with nodal recurrence detected on either (11C) choline PET/CT scan or with conventional imaging. Patients in the studies underwent extended pelvic +/- retroperitoneal salvage lymph node dissections (sLND). For patients not on ADT after RP (n=162), the 5 year recurrence free and cancer-specific survival rates were 47% and 86%, respectively. On multivariate analyses, only the number of positive nodes, and complete PSA response represented independent predictors of recurrence after sLND. Those without complete PSA response and/or with > 2 nodes at sLND had a 2-fold increased probability of recurrence at 5 years. For those on ADT post-RP (n=47), the 5-year recurrence-free and cancer-specific survival rates were 47% and 69%, respectively.
The management of patients with systemic progression after radical prostatectomy (RP) and adjuvant or salvage therapy is challenging. These patients are typically considered for second-line hormonal therapy, chemotherapy, or clinical trials testing novel agents. Salvage LND is associated with biochemical recurrence-free rates of 40% at 5 years in selected patients with nodal recurrence after RP. For men on ADT after RP, ~30% will achieve immediate PSA response with half of those being biochemically free of disease at 5 years. As such, these strategies can allow for at least a delay in the use of further treatments in this complex patient population.
Salvage lymph node dissection for patients treated with radical prostatectomy with biochemical recurrence and imaging-detected nodal metastases
Nazareno Suardi, Jeffrey Karnes, Steven Joniau, Karim Touijer, Daniar Osmonov, Alberto Briganti, Marco Bianchi, Hein Van Poppel, Patrizio Rigatti, Francesco Montorsi, and Klaus Peter Juneman
Is there a role for salvage extended lymph node dissection for patients with nodal recurrence of prostate cancer on androgen deprivation therapy? Results based on a multi-institutional analysis
Daniar Osmonov, Alberto Briganti, Jeffrey Karnes, Steven Joniau, Karim Touijer, Patrizio Rigatti, Nazareno Suardi, Klaus-Peter Junemann, Francesco Montorsi, and Hein Van Poppel
Presented at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Reported for UroToday.com by Anthony T. Corcoran, MD
