Cargando…
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...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
---|---|
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 |
_version_ | 1784853833362440192 |
---|---|
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. |
format | Online Article Text |
id | pubmed-9766859 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT bravicarloa combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT heidenreichaxel combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT fossatinicola combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT gandagliagiorgio combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT suardinazareno combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT mazzoneelio combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT stabilearmando combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT cucchiaravito combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT osmonovdaniar combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT juenemannklauspeter combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT karnesrjeffrey combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT kretschmeralexander combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT buchneralexander combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT stiefchristian combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT hiesterandreas combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT alberspeter combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT devosgaetan combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT joniausteven combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT vanpoppelhendrik combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT grubmullerbernhard combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT shariatshahrokh combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT tilkiderya combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT graefenmarkus combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT gillinderbirs combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT mottriealexander combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT karakiewiczpierrei combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT montorsifrancesco combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT brigantialberto combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer AT pfisterdavid combiningpsaandpetfeaturestoselectcandidatesforsalvagelymphnodedissectioninrecurrentprostatecancer |