Bravi, Carlo A., Fossati, Nicola, Gandaglia, Giorgio, Suardi, Nazareno ORCID: 0000-0002-4331-3010, Mazzone, Elio, Robesti, Daniele, Osmonov, Daniar, Juenemann, Klaus-Peter, Boeri, Luca, Karnes, R. Jeffrey, Kretschmer, Alexander, Buchner, Alexander ORCID: 0000-0001-7895-7070, Stief, Christian, Hiester, Andreas, Nini, Alessandro ORCID: 0000-0002-2548-6495, Albers, Peter, Devos, Gaetan, Joniau, Steven, Van Poppel, Hendrik, Shariat, Shahrokh F., Heidenreich, Axel, Pfister, David, Tilki, Derya, Graefen, Markus, Gill, Inderbir S., Mottrie, Alexander, Karakiewicz, Pierre, I, Montorsi, Francesco and Briganti, Alberto (2020). Assessing the Best Surgical Template at Salvage Pelvic Lymph Node Dissection for Nodal Recurrence of Prostate Cancer After Radical Prostatectomy: When Can Bilateral Dissection be Omitted? Results from a Multi-institutional Series. Eur. Urol., 78 (6). S. 779 - 783. AMSTERDAM: ELSEVIER. ISSN 1873-7560

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Abstract

The best surgical template for salvage pelvic lymph node dissection (sLND) in patients with nodal recurrence from prostate cancer (PCa) after radical prostatectomy (RP) is currently unknown. We analyzed data of 189 patients with a unilateral positive positron emission tomography (PET) scan of the pelvic lymph node areas, who were treated with bilateral pelvic sLND after RP at 11 high-volume centers. The primary endpoint was missed contralateral disease at final pathology, defined as lymph node positive for PCa in the side opposite to the positive spot(s) at the PET scan. Overall, 93 (49%) and 96 (51%) patients received a C-11-choline and a Ga-68 prostate-specific membrane antigen (PSMA) PET scan, respectively, and 171 (90%) and 18 (10%) men had one and two positive spots, respectively. The rate of missed contralateral PCa was 18% (34/189), with the rates being 17% (29/171) and 28% (5/18) in men with one and two positive spots, respectively. While the rate of contralateral disease did not differ between Ga-68-PSMA and C-11-choline (29% and 27%, respectively) among men with two positive spots, the rate of contralateral PCa was only 6% with Ga-68-PSMA versus 28% with C-11-choline in patients with a single positive spot. This finding was confirmed at multivariable logistic regression analysis predicting missed disease at final pathology after accounting for confounders (odds ratio: 0.24; p = 0.001). However, in men with a single positive spot at Ga-68-PSMA PET/computed tomography, the rate of single confirmed lymph node metastasis at final pathology was only 33%, suggesting the need for extended template even if unilateral dissection is performed. Awaiting confirmatory studies, patients diagnosed with a single positive spot at the Ga-68-PSMA PET scan might be considered for unilateral extended pelvic sLND. Patient summary: We assessed the risk of missing contralateral disease in patients with a positron emission tomography (PET) scan suggestive of unilateral nodal recurrence from prostate cancer (PCa) after radical prostatectomy and who were treated with bilateral salvage lymph node dissection (sLND). Variability exists accord-ing to the number of positive spots and PET tracer, with the lowest rate of missed PCa in men diagnosed with a single positive spot at a Ga-68 prostate-specific membrane antigen PET scan (6%). If replicated, our data suggest that these patients might be considered for unilateral extended pelvic sLND. (c) 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Bravi, Carlo A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fossati, NicolaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gandaglia, GiorgioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Suardi, NazarenoUNSPECIFIEDorcid.org/0000-0002-4331-3010UNSPECIFIED
Mazzone, ElioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Robesti, DanieleUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Osmonov, DaniarUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Juenemann, Klaus-PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Boeri, LucaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Karnes, R. JeffreyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kretschmer, AlexanderUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Buchner, AlexanderUNSPECIFIEDorcid.org/0000-0001-7895-7070UNSPECIFIED
Stief, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hiester, AndreasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nini, AlessandroUNSPECIFIEDorcid.org/0000-0002-2548-6495UNSPECIFIED
Albers, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Devos, GaetanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Joniau, StevenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Van Poppel, HendrikUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Shariat, Shahrokh F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heidenreich, AxelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pfister, DavidUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Tilki, DeryaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Graefen, MarkusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gill, Inderbir S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mottrie, AlexanderUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Karakiewicz, Pierre, IUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Montorsi, FrancescoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Briganti, AlbertoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-309775
DOI: 10.1016/j.eururo.2020.06.047
Journal or Publication Title: Eur. Urol.
Volume: 78
Number: 6
Page Range: S. 779 - 783
Date: 2020
Publisher: ELSEVIER
Place of Publication: AMSTERDAM
ISSN: 1873-7560
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
Urology & NephrologyMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/30977

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