Cohort Study of Oligorecurrent Prostate Cancer Patients: Oncological Outcomes of Patients Treated with Salvage Lymph Node Dissection via Prostate-specific Membrane Antigen–radioguided Surgery
In oligorecurrent prostate cancer patients, salvage surgery of metastatic soft-tissue lesions constitutes an experimental treatment approach. Careful patient selection is mandatory based on life expectancy, low prostate-specific antigen values, and low number of prostate-specific membrane antigen po...
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| Veröffentlicht in: | European urology 2023-01, Vol.83 (1), p.62-69 |
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| creator | Knipper, Sophie Mehdi Irai, Mehrdad Simon, Ricarda Koehler, Daniel Rauscher, Isabel Eiber, Matthias van Leeuwen, Fijs W.B. van Leeuwen, Pim de Barros, Hilda van der Poel, Henk Budäus, Lars Steuber, Thomas Graefen, Markus Tennstedt, Pierre Heck, Matthias M. Horn, Thomas Maurer, Tobias |
| description | In oligorecurrent prostate cancer patients, salvage surgery of metastatic soft-tissue lesions constitutes an experimental treatment approach. Careful patient selection is mandatory based on life expectancy, low prostate-specific antigen values, and low number of prostate-specific membrane antigen positron emission tomography avid lesions located in the pelvis.
In a subset of patients with recurrent oligometastatic prostate cancer (PCa) salvage surgery with prostate-specific membrane antigen (PSMA)-targeted radioguidance (PSMA-RGS) might be of value.
To evaluate the oncological outcomes of salvage PSMA-RGS and determine the predictive preoperative factors of improved outcomes.
A cohort study of oligorecurrent PCa patients with biochemical recurrence (BCR) after radical prostatectomy and imaging with PSMA positron emission tomography (PET), treated with PSMA-RGS in two tertiary care centers (2014–2020), was conducted.
PSMA-RGS.
Kaplan-Meier and multivariable Cox regression models were used to assess BCR-free (BFS) and therapy-free (TFS) survival. Postoperative complications were classified according to Clavien-Dindo.
Overall, 364 patients without concomitant treatment were assessed. At PSMA-RGS, metastatic soft-tissue PCa lesions were removed in 343 (94%) patients. At 2–16 wk after PSMA-RGS, 165 patients reached a prostate-specific antigen (PSA) level of |
| doi_str_mv | 10.1016/j.eururo.2022.05.031 |
| format | Article |
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In a subset of patients with recurrent oligometastatic prostate cancer (PCa) salvage surgery with prostate-specific membrane antigen (PSMA)-targeted radioguidance (PSMA-RGS) might be of value.
To evaluate the oncological outcomes of salvage PSMA-RGS and determine the predictive preoperative factors of improved outcomes.
A cohort study of oligorecurrent PCa patients with biochemical recurrence (BCR) after radical prostatectomy and imaging with PSMA positron emission tomography (PET), treated with PSMA-RGS in two tertiary care centers (2014–2020), was conducted.
PSMA-RGS.
Kaplan-Meier and multivariable Cox regression models were used to assess BCR-free (BFS) and therapy-free (TFS) survival. Postoperative complications were classified according to Clavien-Dindo.
Overall, 364 patients without concomitant treatment were assessed. At PSMA-RGS, metastatic soft-tissue PCa lesions were removed in 343 (94%) patients. At 2–16 wk after PSMA-RGS, 165 patients reached a prostate-specific antigen (PSA) level of <0.2 ng/ml. Within 3 mo, 24 (6.6%) patients suffered from Clavien-Dindo complications grade III–IV. At 2 yr, BFS and TFS rates were 32% and 58%, respectively. In multivariable analyses, higher preoperative PSA (hazard ratio [HR]: 1.07, 95% confidence interval [CI]: 1.02–1.12), higher number of PSMA-avid lesions (HR: 1.23, CI: 1.08–1.40), multiple (pelvic plus retroperitoneal) localizations (HR: 1.90, CI: 1.23–2.95), and retroperitoneal localization (HR: 2.04, CI: 1.31–3.18) of lesions in preoperative imaging were independent predictors of BCR after PSMA-RGS. The main limitation is the lack of a control group.
As salvage surgery in oligorecurrent PCa currently constitutes an experimental treatment approach, careful patient selection is mandatory based on life expectancy, low PSA values, and low number of PSMA PET–avid lesions located in the pelvis.
We looked at the outcomes from prostate cancer patients with recurrent disease after radical prostatectomy. We found that surgery may be an opportunity to prolong treatment-free survival, but patient selection criteria need to be very narrow.</description><identifier>ISSN: 0302-2838</identifier><identifier>EISSN: 1873-7560</identifier><identifier>DOI: 10.1016/j.eururo.2022.05.031</identifier><identifier>PMID: 35718637</identifier><language>eng</language><publisher>Switzerland: Elsevier B.V</publisher><subject>Biochemical recurrence ; Cohort Studies ; Gallium Radioisotopes ; Humans ; Lymph Node Excision - methods ; Male ; Neoplasm Recurrence, Local - pathology ; Oligometastatic disease ; Prostate - pathology ; Prostate cancer ; Prostate-Specific Antigen ; Prostate-specific membrane antigen positron emission tomography ; Prostate-specific membrane antigen–radioguided surgery ; Prostatectomy - adverse effects ; Prostatic Neoplasms - diagnostic imaging ; Prostatic Neoplasms - surgery ; Salvage Therapy - methods ; Surgery, Computer-Assisted - methods</subject><ispartof>European urology, 2023-01, Vol.83 (1), p.62-69</ispartof><rights>2022 European Association of Urology</rights><rights>Copyright © 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c408t-d89708e1b75bfbf107ead7e6c210dbd20ceeb5201ec3a6a96e5d569528b0e9353</citedby><cites>FETCH-LOGICAL-c408t-d89708e1b75bfbf107ead7e6c210dbd20ceeb5201ec3a6a96e5d569528b0e9353</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0302283822024083$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35718637$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Knipper, Sophie</creatorcontrib><creatorcontrib>Mehdi Irai, Mehrdad</creatorcontrib><creatorcontrib>Simon, Ricarda</creatorcontrib><creatorcontrib>Koehler, Daniel</creatorcontrib><creatorcontrib>Rauscher, Isabel</creatorcontrib><creatorcontrib>Eiber, Matthias</creatorcontrib><creatorcontrib>van Leeuwen, Fijs W.B.</creatorcontrib><creatorcontrib>van Leeuwen, Pim</creatorcontrib><creatorcontrib>de Barros, Hilda</creatorcontrib><creatorcontrib>van der Poel, Henk</creatorcontrib><creatorcontrib>Budäus, Lars</creatorcontrib><creatorcontrib>Steuber, Thomas</creatorcontrib><creatorcontrib>Graefen, Markus</creatorcontrib><creatorcontrib>Tennstedt, Pierre</creatorcontrib><creatorcontrib>Heck, Matthias M.</creatorcontrib><creatorcontrib>Horn, Thomas</creatorcontrib><creatorcontrib>Maurer, Tobias</creatorcontrib><title>Cohort Study of Oligorecurrent Prostate Cancer Patients: Oncological Outcomes of Patients Treated with Salvage Lymph Node Dissection via Prostate-specific Membrane Antigen–radioguided Surgery</title><title>European urology</title><addtitle>Eur Urol</addtitle><description>In oligorecurrent prostate cancer patients, salvage surgery of metastatic soft-tissue lesions constitutes an experimental treatment approach. Careful patient selection is mandatory based on life expectancy, low prostate-specific antigen values, and low number of prostate-specific membrane antigen positron emission tomography avid lesions located in the pelvis.
In a subset of patients with recurrent oligometastatic prostate cancer (PCa) salvage surgery with prostate-specific membrane antigen (PSMA)-targeted radioguidance (PSMA-RGS) might be of value.
To evaluate the oncological outcomes of salvage PSMA-RGS and determine the predictive preoperative factors of improved outcomes.
A cohort study of oligorecurrent PCa patients with biochemical recurrence (BCR) after radical prostatectomy and imaging with PSMA positron emission tomography (PET), treated with PSMA-RGS in two tertiary care centers (2014–2020), was conducted.
PSMA-RGS.
Kaplan-Meier and multivariable Cox regression models were used to assess BCR-free (BFS) and therapy-free (TFS) survival. Postoperative complications were classified according to Clavien-Dindo.
Overall, 364 patients without concomitant treatment were assessed. At PSMA-RGS, metastatic soft-tissue PCa lesions were removed in 343 (94%) patients. At 2–16 wk after PSMA-RGS, 165 patients reached a prostate-specific antigen (PSA) level of <0.2 ng/ml. Within 3 mo, 24 (6.6%) patients suffered from Clavien-Dindo complications grade III–IV. At 2 yr, BFS and TFS rates were 32% and 58%, respectively. In multivariable analyses, higher preoperative PSA (hazard ratio [HR]: 1.07, 95% confidence interval [CI]: 1.02–1.12), higher number of PSMA-avid lesions (HR: 1.23, CI: 1.08–1.40), multiple (pelvic plus retroperitoneal) localizations (HR: 1.90, CI: 1.23–2.95), and retroperitoneal localization (HR: 2.04, CI: 1.31–3.18) of lesions in preoperative imaging were independent predictors of BCR after PSMA-RGS. The main limitation is the lack of a control group.
As salvage surgery in oligorecurrent PCa currently constitutes an experimental treatment approach, careful patient selection is mandatory based on life expectancy, low PSA values, and low number of PSMA PET–avid lesions located in the pelvis.
We looked at the outcomes from prostate cancer patients with recurrent disease after radical prostatectomy. We found that surgery may be an opportunity to prolong treatment-free survival, but patient selection criteria need to be very narrow.</description><subject>Biochemical recurrence</subject><subject>Cohort Studies</subject><subject>Gallium Radioisotopes</subject><subject>Humans</subject><subject>Lymph Node Excision - methods</subject><subject>Male</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Oligometastatic disease</subject><subject>Prostate - pathology</subject><subject>Prostate cancer</subject><subject>Prostate-Specific Antigen</subject><subject>Prostate-specific membrane antigen positron emission tomography</subject><subject>Prostate-specific membrane antigen–radioguided surgery</subject><subject>Prostatectomy - adverse effects</subject><subject>Prostatic Neoplasms - diagnostic imaging</subject><subject>Prostatic Neoplasms - surgery</subject><subject>Salvage Therapy - methods</subject><subject>Surgery, Computer-Assisted - methods</subject><issn>0302-2838</issn><issn>1873-7560</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcuO0zAUhi0EYkrhDRDykk2CL3WcskAalatU6Egd1pZjn6SukrjYTlF3vANPxKvwJLjqzCxZWTr6Lz7nQ-glJSUltHqzL2EKU_AlI4yVRJSE00doRmvJCykq8hjNCCesYDWvr9CzGPeEEC6W_Cm64kLSuuJyhv6s_M6HhLdpsifsW7zpXecDmCkEGBO-CT4mnQCv9Ggg4BudXJ7Ht3gzGt_7zhnd482UjB8gngPuFfg2QDZa_NOlHd7q_qg7wOvTcNjhb94Cfu9iBJOcH_HR6YemIh7AuNYZ_BWGJugR8PWYXAfj31-_g7bOd5OzOXc7hQ7C6Tl60uo-wou7d46-f_xwu_pcrDefvqyu14VZkDoVtl5KUgNtpGjapqVEgrYSKsMosY1lxAA0ghEKhutKLysQVlRLweqGwJILPkevL7mH4H9MEJMaXDTQ9_mHfoqKVbKWC87yhedocZGavFMM0KpDcIMOJ0WJOsNTe3WBp87wFBEqw8u2V3cNUzOAfTDd08qCdxcB5D2PDoKKJt_agHWZWFLWu_83_APum7O1</recordid><startdate>202301</startdate><enddate>202301</enddate><creator>Knipper, Sophie</creator><creator>Mehdi Irai, Mehrdad</creator><creator>Simon, Ricarda</creator><creator>Koehler, Daniel</creator><creator>Rauscher, Isabel</creator><creator>Eiber, Matthias</creator><creator>van Leeuwen, Fijs W.B.</creator><creator>van Leeuwen, Pim</creator><creator>de Barros, Hilda</creator><creator>van der Poel, Henk</creator><creator>Budäus, Lars</creator><creator>Steuber, Thomas</creator><creator>Graefen, Markus</creator><creator>Tennstedt, Pierre</creator><creator>Heck, Matthias M.</creator><creator>Horn, Thomas</creator><creator>Maurer, Tobias</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202301</creationdate><title>Cohort Study of Oligorecurrent Prostate Cancer Patients: Oncological Outcomes of Patients Treated with Salvage Lymph Node Dissection via Prostate-specific Membrane Antigen–radioguided Surgery</title><author>Knipper, Sophie ; Mehdi Irai, Mehrdad ; Simon, Ricarda ; Koehler, Daniel ; Rauscher, Isabel ; Eiber, Matthias ; van Leeuwen, Fijs W.B. ; van Leeuwen, Pim ; de Barros, Hilda ; van der Poel, Henk ; Budäus, Lars ; Steuber, Thomas ; Graefen, Markus ; Tennstedt, Pierre ; Heck, Matthias M. ; Horn, Thomas ; Maurer, Tobias</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c408t-d89708e1b75bfbf107ead7e6c210dbd20ceeb5201ec3a6a96e5d569528b0e9353</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Biochemical recurrence</topic><topic>Cohort Studies</topic><topic>Gallium Radioisotopes</topic><topic>Humans</topic><topic>Lymph Node Excision - methods</topic><topic>Male</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Oligometastatic disease</topic><topic>Prostate - pathology</topic><topic>Prostate cancer</topic><topic>Prostate-Specific Antigen</topic><topic>Prostate-specific membrane antigen positron emission tomography</topic><topic>Prostate-specific membrane antigen–radioguided surgery</topic><topic>Prostatectomy - adverse effects</topic><topic>Prostatic Neoplasms - diagnostic imaging</topic><topic>Prostatic Neoplasms - surgery</topic><topic>Salvage Therapy - methods</topic><topic>Surgery, Computer-Assisted - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Knipper, Sophie</creatorcontrib><creatorcontrib>Mehdi Irai, Mehrdad</creatorcontrib><creatorcontrib>Simon, Ricarda</creatorcontrib><creatorcontrib>Koehler, Daniel</creatorcontrib><creatorcontrib>Rauscher, Isabel</creatorcontrib><creatorcontrib>Eiber, Matthias</creatorcontrib><creatorcontrib>van Leeuwen, Fijs W.B.</creatorcontrib><creatorcontrib>van Leeuwen, Pim</creatorcontrib><creatorcontrib>de Barros, Hilda</creatorcontrib><creatorcontrib>van der Poel, Henk</creatorcontrib><creatorcontrib>Budäus, Lars</creatorcontrib><creatorcontrib>Steuber, Thomas</creatorcontrib><creatorcontrib>Graefen, Markus</creatorcontrib><creatorcontrib>Tennstedt, Pierre</creatorcontrib><creatorcontrib>Heck, Matthias M.</creatorcontrib><creatorcontrib>Horn, Thomas</creatorcontrib><creatorcontrib>Maurer, Tobias</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European urology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Knipper, Sophie</au><au>Mehdi Irai, Mehrdad</au><au>Simon, Ricarda</au><au>Koehler, Daniel</au><au>Rauscher, Isabel</au><au>Eiber, Matthias</au><au>van Leeuwen, Fijs W.B.</au><au>van Leeuwen, Pim</au><au>de Barros, Hilda</au><au>van der Poel, Henk</au><au>Budäus, Lars</au><au>Steuber, Thomas</au><au>Graefen, Markus</au><au>Tennstedt, Pierre</au><au>Heck, Matthias M.</au><au>Horn, Thomas</au><au>Maurer, Tobias</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cohort Study of Oligorecurrent Prostate Cancer Patients: Oncological Outcomes of Patients Treated with Salvage Lymph Node Dissection via Prostate-specific Membrane Antigen–radioguided Surgery</atitle><jtitle>European urology</jtitle><addtitle>Eur Urol</addtitle><date>2023-01</date><risdate>2023</risdate><volume>83</volume><issue>1</issue><spage>62</spage><epage>69</epage><pages>62-69</pages><issn>0302-2838</issn><eissn>1873-7560</eissn><abstract>In oligorecurrent prostate cancer patients, salvage surgery of metastatic soft-tissue lesions constitutes an experimental treatment approach. Careful patient selection is mandatory based on life expectancy, low prostate-specific antigen values, and low number of prostate-specific membrane antigen positron emission tomography avid lesions located in the pelvis.
In a subset of patients with recurrent oligometastatic prostate cancer (PCa) salvage surgery with prostate-specific membrane antigen (PSMA)-targeted radioguidance (PSMA-RGS) might be of value.
To evaluate the oncological outcomes of salvage PSMA-RGS and determine the predictive preoperative factors of improved outcomes.
A cohort study of oligorecurrent PCa patients with biochemical recurrence (BCR) after radical prostatectomy and imaging with PSMA positron emission tomography (PET), treated with PSMA-RGS in two tertiary care centers (2014–2020), was conducted.
PSMA-RGS.
Kaplan-Meier and multivariable Cox regression models were used to assess BCR-free (BFS) and therapy-free (TFS) survival. Postoperative complications were classified according to Clavien-Dindo.
Overall, 364 patients without concomitant treatment were assessed. At PSMA-RGS, metastatic soft-tissue PCa lesions were removed in 343 (94%) patients. At 2–16 wk after PSMA-RGS, 165 patients reached a prostate-specific antigen (PSA) level of <0.2 ng/ml. Within 3 mo, 24 (6.6%) patients suffered from Clavien-Dindo complications grade III–IV. At 2 yr, BFS and TFS rates were 32% and 58%, respectively. In multivariable analyses, higher preoperative PSA (hazard ratio [HR]: 1.07, 95% confidence interval [CI]: 1.02–1.12), higher number of PSMA-avid lesions (HR: 1.23, CI: 1.08–1.40), multiple (pelvic plus retroperitoneal) localizations (HR: 1.90, CI: 1.23–2.95), and retroperitoneal localization (HR: 2.04, CI: 1.31–3.18) of lesions in preoperative imaging were independent predictors of BCR after PSMA-RGS. The main limitation is the lack of a control group.
As salvage surgery in oligorecurrent PCa currently constitutes an experimental treatment approach, careful patient selection is mandatory based on life expectancy, low PSA values, and low number of PSMA PET–avid lesions located in the pelvis.
We looked at the outcomes from prostate cancer patients with recurrent disease after radical prostatectomy. We found that surgery may be an opportunity to prolong treatment-free survival, but patient selection criteria need to be very narrow.</abstract><cop>Switzerland</cop><pub>Elsevier B.V</pub><pmid>35718637</pmid><doi>10.1016/j.eururo.2022.05.031</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0302-2838 |
| ispartof | European urology, 2023-01, Vol.83 (1), p.62-69 |
| issn | 0302-2838 1873-7560 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2678743259 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Biochemical recurrence Cohort Studies Gallium Radioisotopes Humans Lymph Node Excision - methods Male Neoplasm Recurrence, Local - pathology Oligometastatic disease Prostate - pathology Prostate cancer Prostate-Specific Antigen Prostate-specific membrane antigen positron emission tomography Prostate-specific membrane antigen–radioguided surgery Prostatectomy - adverse effects Prostatic Neoplasms - diagnostic imaging Prostatic Neoplasms - surgery Salvage Therapy - methods Surgery, Computer-Assisted - methods |
| title | Cohort Study of Oligorecurrent Prostate Cancer Patients: Oncological Outcomes of Patients Treated with Salvage Lymph Node Dissection via Prostate-specific Membrane Antigen–radioguided Surgery |
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