Universität zu Köln

Bravi, Carlo A., Droghetti, Matteo ORCID: 0000-0002-9190-4691, Fossati, Nicola, Gandaglia, Giorgio, Suardi, Nazareno, Mazzone, Elio, Cucchiara, Vito, Scuderi, Simone, Barletta, Francesco, Schiavina, Riccardo, 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, Grubmueller, Bernhard, Shariat, Shahrokh F., Heidenreich, Axel, Pfister, David, Tilki, Derya, Graefen, Markus, Gill, Inderbir S., Mottrie, Alexandre, Karakiewicz, Pierre, I, Montorsi, Francesco and Briganti, Alberto (2022). Definition and Impact on Oncologic Outcomes of Persistently Elevated Prostate-specific Antigen After Salvage Lymph Node Dissection for Node-only Recurrent Prostate Cancer After Radical Prostatectomy: Clinical Implications for Multimodal Therapy. Eur. Urol. Oncol., 5 (3). S. 285 - 296. AMSTERDAM: ELSEVIER. ISSN 2588-9311

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Abstract

Background: The optimal definition and prognostic significance of persistently elevated prostate-specific antigen (PSA) after salvage lymph node dissection (sLND) for node-only recurrent prostate cancer (PCa) remain unknown. Objective: To assess the definition and clinical implications of persistently elevated PSA after sLND for node-only recurrent PCa after radical prostatectomy. Design, setting, and participants: The study included 579 patients treated with sLND at 11 high-volume centers between 2000 and 2016. Outcome measurements and statistical analysis: We assessed the linear relationship between the first PSA after sLND and death from PCa. Different definitions of PSA persistence were included in a multivariable model predicting cancer-specific mortality (CSM) after surgery to identify the best cutoff value. We investigated the association between PSA persistence and oncologic outcomes using multivariable regression models. Moreover, the effect of early androgen deprivation therapy (ADT) after sLND was tested according to PSA persistence status and estimated risk of CSM. Results and limitations: We found an inverse relationship between the first PSA after sLND and the probability of cancer-specific survival. PSA persistence defined as first postoperative PSA >= 0.3 ng/ml provided the best discrimination accuracy (C index 0.757). According to this cutoff, 331 patients (57%) experienced PSA persistence. The median follow-up for survivors was 48 mo (interquartile range 27-74). After adjusting for confounders, men with persistently elevated PSA had higher risk of clinical recurrence (hazard ratio [HR] 1.61), overall mortality (HR 2.20), and CSM (HR 2.59; all p < 0.001) after sLND. Early ADT administration after sLND improved survival only for patients with PSA persistence after surgery (HR 0.49; p = 0.024). Similarly, when PSA persistence status was included in multivariable models accounting for pathologic features, early ADT use after sLND was beneficial only for patients with a predicted risk of CSM at 5 yr of >10%. Conclusions: PSA persistence after sLND independently predicts adverse prognosis, with the best discrimination accuracy for CSM provided by a definition of PSA >= 0.3 ng/ml. We showed that when stratifying patients by final pathology results and PSA persistence status, early ADT use after sLND was beneficial only for patients with PSA persistence or with a calculated 5-yr risk of CSM of >10%, which could be useful as we await results from ongoing prospective trials. Patient summary: We found that for patients with prostate cancer who had lymph nodes removed after their cancer recurred, persistently elevated prostate-specific antigen (PSA) levels predict poorer prognosis. We showed that a PSA level of >= 0.3 ng/ ml provides the best accuracy in identifying patients with worse prognosis. This may help to improve risk stratification after lymph node removal and allow physicians to optimize treatment strategies after surgery. (c) 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Bravi, Carlo A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Droghetti, Matteo UNSPECIFIED orcid.org/0000-0002-9190-4691 UNSPECIFIED Fossati, Nicola UNSPECIFIED UNSPECIFIED UNSPECIFIED Gandaglia, Giorgio UNSPECIFIED UNSPECIFIED UNSPECIFIED Suardi, Nazareno UNSPECIFIED UNSPECIFIED UNSPECIFIED Mazzone, Elio UNSPECIFIED UNSPECIFIED UNSPECIFIED Cucchiara, Vito UNSPECIFIED UNSPECIFIED UNSPECIFIED Scuderi, Simone UNSPECIFIED UNSPECIFIED UNSPECIFIED Barletta, Francesco UNSPECIFIED UNSPECIFIED UNSPECIFIED Schiavina, Riccardo UNSPECIFIED UNSPECIFIED UNSPECIFIED Osmonov, Daniar UNSPECIFIED UNSPECIFIED UNSPECIFIED Juenemann, Klaus-Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Boeri, Luca UNSPECIFIED UNSPECIFIED UNSPECIFIED Karnes, R. Jeffrey UNSPECIFIED UNSPECIFIED UNSPECIFIED Kretschmer, Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED Buchner, Alexander UNSPECIFIED orcid.org/0000-0001-7895-7070 UNSPECIFIED Stief, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Hiester, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Nini, Alessandro UNSPECIFIED orcid.org/0000-0002-2548-6495 UNSPECIFIED Albers, Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Devos, Gaetan UNSPECIFIED UNSPECIFIED UNSPECIFIED Joniau, Steven UNSPECIFIED UNSPECIFIED UNSPECIFIED Van Poppel, Hendrik UNSPECIFIED UNSPECIFIED UNSPECIFIED Grubmueller, Bernhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Shariat, Shahrokh F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Heidenreich, Axel UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfister, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Tilki, Derya UNSPECIFIED UNSPECIFIED UNSPECIFIED Graefen, Markus UNSPECIFIED UNSPECIFIED UNSPECIFIED Gill, Inderbir S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Mottrie, Alexandre UNSPECIFIED UNSPECIFIED UNSPECIFIED Karakiewicz, Pierre, I UNSPECIFIED UNSPECIFIED UNSPECIFIED Montorsi, Francesco UNSPECIFIED UNSPECIFIED UNSPECIFIED Briganti, Alberto UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-696497
DOI:	10.1016/j.euo.2021.06.003
Journal or Publication Title:	Eur. Urol. Oncol.
Volume:	5
Number:	3
Page Range:	S. 285 - 296
Date:	2022
Publisher:	ELSEVIER
Place of Publication:	AMSTERDAM
ISSN:	2588-9311
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language LONG-TERM OUTCOMES; BIOCHEMICAL RECURRENCE; EXPERIENCE; SURVIVAL Multiple languages Oncology; Urology & Nephrology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/69649