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Combining PSA and PET features to select candidates for salvage lymph node dissection in recurrent prostate cancer

OBJECTIVE: To evaluate the relationship between pre‐operative PSA value, (68)Ga‐prostate‐specific‐membrane‐antigen (PSMA) PET performance and oncologic outcomes after salvage lymph node dissection (sLND) for biochemical recurrent prostate cancer (PCa). PATIENTS AND METHODS: The study included 164 pa...

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Autores principales: Bravi, Carlo A., Heidenreich, Axel, Fossati, Nicola, Gandaglia, Giorgio, Suardi, Nazareno, Mazzone, Elio, Stabile, Armando, Cucchiara, Vito, Osmonov, Daniar, Juenemann, Klaus‐Peter, Karnes, R. Jeffrey, Kretschmer, Alexander, Buchner, Alexander, Stief, Christian, Hiester, Andreas, Albers, Peter, Devos, Gaëtan, Joniau, Steven, Van Poppel, Hendrik, Grubmüller, Bernhard, Shariat, Shahrokh, Tilki, Derya, Graefen, Markus, Gill, Inderbir S., Mottrie, Alexander, Karakiewicz, Pierre I., Montorsi, Francesco, Briganti, Alberto, Pfister, David
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9766859/
https://www.ncbi.nlm.nih.gov/pubmed/36569505
http://dx.doi.org/10.1002/bco2.182
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author Bravi, Carlo A.
Heidenreich, Axel
Fossati, Nicola
Gandaglia, Giorgio
Suardi, Nazareno
Mazzone, Elio
Stabile, Armando
Cucchiara, Vito
Osmonov, Daniar
Juenemann, Klaus‐Peter
Karnes, R. Jeffrey
Kretschmer, Alexander
Buchner, Alexander
Stief, Christian
Hiester, Andreas
Albers, Peter
Devos, Gaëtan
Joniau, Steven
Van Poppel, Hendrik
Grubmüller, Bernhard
Shariat, Shahrokh
Tilki, Derya
Graefen, Markus
Gill, Inderbir S.
Mottrie, Alexander
Karakiewicz, Pierre I.
Montorsi, Francesco
Briganti, Alberto
Pfister, David
author_facet Bravi, Carlo A.
Heidenreich, Axel
Fossati, Nicola
Gandaglia, Giorgio
Suardi, Nazareno
Mazzone, Elio
Stabile, Armando
Cucchiara, Vito
Osmonov, Daniar
Juenemann, Klaus‐Peter
Karnes, R. Jeffrey
Kretschmer, Alexander
Buchner, Alexander
Stief, Christian
Hiester, Andreas
Albers, Peter
Devos, Gaëtan
Joniau, Steven
Van Poppel, Hendrik
Grubmüller, Bernhard
Shariat, Shahrokh
Tilki, Derya
Graefen, Markus
Gill, Inderbir S.
Mottrie, Alexander
Karakiewicz, Pierre I.
Montorsi, Francesco
Briganti, Alberto
Pfister, David
author_sort Bravi, Carlo A.
collection PubMed
description OBJECTIVE: To evaluate the relationship between pre‐operative PSA value, (68)Ga‐prostate‐specific‐membrane‐antigen (PSMA) PET performance and oncologic outcomes after salvage lymph node dissection (sLND) for biochemical recurrent prostate cancer (PCa). PATIENTS AND METHODS: The study included 164 patients diagnosed with ≤2 pelvic lymph‐node recurrence(s) of PCa documented on (68)Ga‐PSMA PET scan and treated with pelvic ± retroperitoneal sLND at 11 high‐volume centres between 2012 and 2019. Pathologic findings were correlated to PSA values at time of sLND, categorized in early (<0.5 ng/ml), low (0.5–0.99 ng/ml), moderate (1–1.5 ng/ml) and high (>1.5 ng/ml). Clinical recurrence (CR)‐free survival after sLND was calculated using multivariable analyses and plotted over pre‐operative PSA value. RESULTS: Median [interquartile range (IQR)] PSA at sLND was 1.1 (0.6, 2.0) ng/ml, and 131 (80%) patients had one positive spot at PET scan. All patients received pelvic sLND, whereas 91 (55%) men received also retroperitoneal dissection. Median (IQR) number of node removed was 15 (6, 28). The rate of positive pathology increased as a function of pre‐operative PSA value, with highest rates for patients with pre‐operative PSA > 1.5 ng/ml (pelvic‐only sLNDs: 84%; pelvic + retroperitoneal sLNDs: 90%). After sLND, PSA ≤ 0.3 ng/ml was detected in 67 (41%) men. On multivariable analyses, pre‐operative PSA was associated with PSA response (p < 0.0001). There were 51 CRs after sLND. After adjusting for confounders, we found a significant, non‐linear relationship between PSA level at sLND and the 12‐month CR‐free survival (p < 0.0001), with the highest probability of freedom from CR for patients who received sLND at PSA level ≥1 ng/ml. CONCLUSIONS: In case of PET‐detected nodal recurrences amenable to sLND, salvage surgery was associated with the highest short‐term oncologic outcomes when performed in men with PSA ≥ 1 ng/ml. Awaiting confirmatory data from prospective trials, these findings may help physicians to optimize the timing for (68)Ga‐PSMA PET in biochemical recurrent PCa.
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spelling pubmed-97668592022-12-23 Combining PSA and PET features to select candidates for salvage lymph node dissection in recurrent prostate cancer Bravi, Carlo A. Heidenreich, Axel Fossati, Nicola Gandaglia, Giorgio Suardi, Nazareno Mazzone, Elio Stabile, Armando Cucchiara, Vito Osmonov, Daniar Juenemann, Klaus‐Peter Karnes, R. Jeffrey Kretschmer, Alexander Buchner, Alexander Stief, Christian Hiester, Andreas Albers, Peter Devos, Gaëtan Joniau, Steven Van Poppel, Hendrik Grubmüller, Bernhard Shariat, Shahrokh Tilki, Derya Graefen, Markus Gill, Inderbir S. Mottrie, Alexander Karakiewicz, Pierre I. Montorsi, Francesco Briganti, Alberto Pfister, David BJUI Compass Original Articles OBJECTIVE: To evaluate the relationship between pre‐operative PSA value, (68)Ga‐prostate‐specific‐membrane‐antigen (PSMA) PET performance and oncologic outcomes after salvage lymph node dissection (sLND) for biochemical recurrent prostate cancer (PCa). PATIENTS AND METHODS: The study included 164 patients diagnosed with ≤2 pelvic lymph‐node recurrence(s) of PCa documented on (68)Ga‐PSMA PET scan and treated with pelvic ± retroperitoneal sLND at 11 high‐volume centres between 2012 and 2019. Pathologic findings were correlated to PSA values at time of sLND, categorized in early (<0.5 ng/ml), low (0.5–0.99 ng/ml), moderate (1–1.5 ng/ml) and high (>1.5 ng/ml). Clinical recurrence (CR)‐free survival after sLND was calculated using multivariable analyses and plotted over pre‐operative PSA value. RESULTS: Median [interquartile range (IQR)] PSA at sLND was 1.1 (0.6, 2.0) ng/ml, and 131 (80%) patients had one positive spot at PET scan. All patients received pelvic sLND, whereas 91 (55%) men received also retroperitoneal dissection. Median (IQR) number of node removed was 15 (6, 28). The rate of positive pathology increased as a function of pre‐operative PSA value, with highest rates for patients with pre‐operative PSA > 1.5 ng/ml (pelvic‐only sLNDs: 84%; pelvic + retroperitoneal sLNDs: 90%). After sLND, PSA ≤ 0.3 ng/ml was detected in 67 (41%) men. On multivariable analyses, pre‐operative PSA was associated with PSA response (p < 0.0001). There were 51 CRs after sLND. After adjusting for confounders, we found a significant, non‐linear relationship between PSA level at sLND and the 12‐month CR‐free survival (p < 0.0001), with the highest probability of freedom from CR for patients who received sLND at PSA level ≥1 ng/ml. CONCLUSIONS: In case of PET‐detected nodal recurrences amenable to sLND, salvage surgery was associated with the highest short‐term oncologic outcomes when performed in men with PSA ≥ 1 ng/ml. Awaiting confirmatory data from prospective trials, these findings may help physicians to optimize the timing for (68)Ga‐PSMA PET in biochemical recurrent PCa. John Wiley and Sons Inc. 2022-08-04 /pmc/articles/PMC9766859/ /pubmed/36569505 http://dx.doi.org/10.1002/bco2.182 Text en © 2022 The Authors. BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Bravi, Carlo A.
Heidenreich, Axel
Fossati, Nicola
Gandaglia, Giorgio
Suardi, Nazareno
Mazzone, Elio
Stabile, Armando
Cucchiara, Vito
Osmonov, Daniar
Juenemann, Klaus‐Peter
Karnes, R. Jeffrey
Kretschmer, Alexander
Buchner, Alexander
Stief, Christian
Hiester, Andreas
Albers, Peter
Devos, Gaëtan
Joniau, Steven
Van Poppel, Hendrik
Grubmüller, Bernhard
Shariat, Shahrokh
Tilki, Derya
Graefen, Markus
Gill, Inderbir S.
Mottrie, Alexander
Karakiewicz, Pierre I.
Montorsi, Francesco
Briganti, Alberto
Pfister, David
Combining PSA and PET features to select candidates for salvage lymph node dissection in recurrent prostate cancer
title Combining PSA and PET features to select candidates for salvage lymph node dissection in recurrent prostate cancer
title_full Combining PSA and PET features to select candidates for salvage lymph node dissection in recurrent prostate cancer
title_fullStr Combining PSA and PET features to select candidates for salvage lymph node dissection in recurrent prostate cancer
title_full_unstemmed Combining PSA and PET features to select candidates for salvage lymph node dissection in recurrent prostate cancer
title_short Combining PSA and PET features to select candidates for salvage lymph node dissection in recurrent prostate cancer
title_sort combining psa and pet features to select candidates for salvage lymph node dissection in recurrent prostate cancer
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9766859/
https://www.ncbi.nlm.nih.gov/pubmed/36569505
http://dx.doi.org/10.1002/bco2.182
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