Mid-term Outcomes Following Salvage Lymph Node Dissection for Prostate Cancer Nodal Recurrence Status Post–radical Prostatectomy

Fabio Zattoni, Avinash Nehra, Christopher R. Murphy, Laureano Rangel, Lance Mynderse, Val Lowe, Eugene D Kwon, Robert Jeffrey Karnes

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background Patients with oligometastatic prostate cancer lymph node recurrence can be treated with many options including salvage lymph node dissection (sLND). Objective Evaluation of outcomes of sLND and identification of clinicopathologic features in predicting further biochemical and radiological relapse after sLND for prostate cancer. Design, setting, and participants Between November 1, 2009 and March 31, 2015, 117 patients with biochemical recurrence (BCR) after radical prostatectomy (RP) underwent sLND by a single surgeon after a standardized 11C-choline positron emission tomography/computed tomography. Outcome measurements and statistical analysis Biochemical response (BR) was defined as a prostate-specific antigen (PSA) < 0.2ng/ml after sLND, BCR was defined as a PSA greater than 0.2 ng/ml with an increased trend after sLND, and radiological recurrence (RAR) was defined as a positive 11C-choline positron emission tomography/computed tomography imaging study or biopsy proven metastasis after sLND. Kaplan-Meier method was used to assess time to BCR, RAR, and cancer-specific mortality. Preoperative and postoperative predictors of BCR and RAR were assessed with Cox regression analyses. Results and limitations All patients had confirmed lymph node metastasis on final sLND pathology. Median follow-up after sLND was 20.2 mo (interquartile range: 11.8–33.6). All but one patient had a decrease in PSA while 93/117 (79.5%) patients achieved BR after sLND. In those who achieved BR, a subsequent BCR occurred in 40% of cases (n = 37/93). The 5-yr BCR, RAR, and cancer-specific mortality-free survival rates were 31%, 51%, and 97% respectively. At multivariate analyses, predictors of both BCR and RAR were pathological stage of the tumor at original RP and whether the nodes were castrate resistant prostate cancer. Given the nonrandomized nature, it is not known how these men would have fared according to survival or quality of life by observation, and/or other systemic therapy. Conclusions An optimal candidate for sLND tends to have pT2 at the original RP and a castration sensitive disease state. sLND could be considered part of a multimodal treatment approach in select patients with castrate-resistant prostate cancer in which delayed/reduced cancer progression could be achieved with a cytoreductive surgery. Patient summary We found that by performing a salvage lymph node dissection there are many men that can experience a biochemical response and eliminate further 11C-choline positron emission tomography/computed tomography radiographic recurrences.

Original languageEnglish (US)
Pages (from-to)522-531
Number of pages10
JournalEuropean Urology Focus
Volume2
Issue number5
DOIs
StatePublished - Dec 1 2016

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Prostatectomy
Lymph Node Excision
Prostatic Neoplasms
Recurrence
Prostate-Specific Antigen
Choline
Neoplasms
Lymph Nodes
Neoplasm Metastasis
Combined Modality Therapy
Mortality
Castration
Multivariate Analysis
Survival Rate

Keywords

  • Biochemical recurrence
  • Choline PET/CT
  • Lymph node metastases
  • Prostate cancers
  • Recurrent prostate cancer
  • Salvage lymph node dissection

ASJC Scopus subject areas

  • Urology

Cite this

Mid-term Outcomes Following Salvage Lymph Node Dissection for Prostate Cancer Nodal Recurrence Status Post–radical Prostatectomy. / Zattoni, Fabio; Nehra, Avinash; Murphy, Christopher R.; Rangel, Laureano; Mynderse, Lance; Lowe, Val; Kwon, Eugene D; Karnes, Robert Jeffrey.

In: European Urology Focus, Vol. 2, No. 5, 01.12.2016, p. 522-531.

Research output: Contribution to journalArticle

Zattoni, Fabio ; Nehra, Avinash ; Murphy, Christopher R. ; Rangel, Laureano ; Mynderse, Lance ; Lowe, Val ; Kwon, Eugene D ; Karnes, Robert Jeffrey. / Mid-term Outcomes Following Salvage Lymph Node Dissection for Prostate Cancer Nodal Recurrence Status Post–radical Prostatectomy. In: European Urology Focus. 2016 ; Vol. 2, No. 5. pp. 522-531.
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title = "Mid-term Outcomes Following Salvage Lymph Node Dissection for Prostate Cancer Nodal Recurrence Status Post–radical Prostatectomy",
abstract = "Background Patients with oligometastatic prostate cancer lymph node recurrence can be treated with many options including salvage lymph node dissection (sLND). Objective Evaluation of outcomes of sLND and identification of clinicopathologic features in predicting further biochemical and radiological relapse after sLND for prostate cancer. Design, setting, and participants Between November 1, 2009 and March 31, 2015, 117 patients with biochemical recurrence (BCR) after radical prostatectomy (RP) underwent sLND by a single surgeon after a standardized 11C-choline positron emission tomography/computed tomography. Outcome measurements and statistical analysis Biochemical response (BR) was defined as a prostate-specific antigen (PSA) < 0.2ng/ml after sLND, BCR was defined as a PSA greater than 0.2 ng/ml with an increased trend after sLND, and radiological recurrence (RAR) was defined as a positive 11C-choline positron emission tomography/computed tomography imaging study or biopsy proven metastasis after sLND. Kaplan-Meier method was used to assess time to BCR, RAR, and cancer-specific mortality. Preoperative and postoperative predictors of BCR and RAR were assessed with Cox regression analyses. Results and limitations All patients had confirmed lymph node metastasis on final sLND pathology. Median follow-up after sLND was 20.2 mo (interquartile range: 11.8–33.6). All but one patient had a decrease in PSA while 93/117 (79.5{\%}) patients achieved BR after sLND. In those who achieved BR, a subsequent BCR occurred in 40{\%} of cases (n = 37/93). The 5-yr BCR, RAR, and cancer-specific mortality-free survival rates were 31{\%}, 51{\%}, and 97{\%} respectively. At multivariate analyses, predictors of both BCR and RAR were pathological stage of the tumor at original RP and whether the nodes were castrate resistant prostate cancer. Given the nonrandomized nature, it is not known how these men would have fared according to survival or quality of life by observation, and/or other systemic therapy. Conclusions An optimal candidate for sLND tends to have pT2 at the original RP and a castration sensitive disease state. sLND could be considered part of a multimodal treatment approach in select patients with castrate-resistant prostate cancer in which delayed/reduced cancer progression could be achieved with a cytoreductive surgery. Patient summary We found that by performing a salvage lymph node dissection there are many men that can experience a biochemical response and eliminate further 11C-choline positron emission tomography/computed tomography radiographic recurrences.",
keywords = "Biochemical recurrence, Choline PET/CT, Lymph node metastases, Prostate cancers, Recurrent prostate cancer, Salvage lymph node dissection",
author = "Fabio Zattoni and Avinash Nehra and Murphy, {Christopher R.} and Laureano Rangel and Lance Mynderse and Val Lowe and Kwon, {Eugene D} and Karnes, {Robert Jeffrey}",
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T1 - Mid-term Outcomes Following Salvage Lymph Node Dissection for Prostate Cancer Nodal Recurrence Status Post–radical Prostatectomy

AU - Zattoni, Fabio

AU - Nehra, Avinash

AU - Murphy, Christopher R.

AU - Rangel, Laureano

AU - Mynderse, Lance

AU - Lowe, Val

AU - Kwon, Eugene D

AU - Karnes, Robert Jeffrey

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Background Patients with oligometastatic prostate cancer lymph node recurrence can be treated with many options including salvage lymph node dissection (sLND). Objective Evaluation of outcomes of sLND and identification of clinicopathologic features in predicting further biochemical and radiological relapse after sLND for prostate cancer. Design, setting, and participants Between November 1, 2009 and March 31, 2015, 117 patients with biochemical recurrence (BCR) after radical prostatectomy (RP) underwent sLND by a single surgeon after a standardized 11C-choline positron emission tomography/computed tomography. Outcome measurements and statistical analysis Biochemical response (BR) was defined as a prostate-specific antigen (PSA) < 0.2ng/ml after sLND, BCR was defined as a PSA greater than 0.2 ng/ml with an increased trend after sLND, and radiological recurrence (RAR) was defined as a positive 11C-choline positron emission tomography/computed tomography imaging study or biopsy proven metastasis after sLND. Kaplan-Meier method was used to assess time to BCR, RAR, and cancer-specific mortality. Preoperative and postoperative predictors of BCR and RAR were assessed with Cox regression analyses. Results and limitations All patients had confirmed lymph node metastasis on final sLND pathology. Median follow-up after sLND was 20.2 mo (interquartile range: 11.8–33.6). All but one patient had a decrease in PSA while 93/117 (79.5%) patients achieved BR after sLND. In those who achieved BR, a subsequent BCR occurred in 40% of cases (n = 37/93). The 5-yr BCR, RAR, and cancer-specific mortality-free survival rates were 31%, 51%, and 97% respectively. At multivariate analyses, predictors of both BCR and RAR were pathological stage of the tumor at original RP and whether the nodes were castrate resistant prostate cancer. Given the nonrandomized nature, it is not known how these men would have fared according to survival or quality of life by observation, and/or other systemic therapy. Conclusions An optimal candidate for sLND tends to have pT2 at the original RP and a castration sensitive disease state. sLND could be considered part of a multimodal treatment approach in select patients with castrate-resistant prostate cancer in which delayed/reduced cancer progression could be achieved with a cytoreductive surgery. Patient summary We found that by performing a salvage lymph node dissection there are many men that can experience a biochemical response and eliminate further 11C-choline positron emission tomography/computed tomography radiographic recurrences.

AB - Background Patients with oligometastatic prostate cancer lymph node recurrence can be treated with many options including salvage lymph node dissection (sLND). Objective Evaluation of outcomes of sLND and identification of clinicopathologic features in predicting further biochemical and radiological relapse after sLND for prostate cancer. Design, setting, and participants Between November 1, 2009 and March 31, 2015, 117 patients with biochemical recurrence (BCR) after radical prostatectomy (RP) underwent sLND by a single surgeon after a standardized 11C-choline positron emission tomography/computed tomography. Outcome measurements and statistical analysis Biochemical response (BR) was defined as a prostate-specific antigen (PSA) < 0.2ng/ml after sLND, BCR was defined as a PSA greater than 0.2 ng/ml with an increased trend after sLND, and radiological recurrence (RAR) was defined as a positive 11C-choline positron emission tomography/computed tomography imaging study or biopsy proven metastasis after sLND. Kaplan-Meier method was used to assess time to BCR, RAR, and cancer-specific mortality. Preoperative and postoperative predictors of BCR and RAR were assessed with Cox regression analyses. Results and limitations All patients had confirmed lymph node metastasis on final sLND pathology. Median follow-up after sLND was 20.2 mo (interquartile range: 11.8–33.6). All but one patient had a decrease in PSA while 93/117 (79.5%) patients achieved BR after sLND. In those who achieved BR, a subsequent BCR occurred in 40% of cases (n = 37/93). The 5-yr BCR, RAR, and cancer-specific mortality-free survival rates were 31%, 51%, and 97% respectively. At multivariate analyses, predictors of both BCR and RAR were pathological stage of the tumor at original RP and whether the nodes were castrate resistant prostate cancer. Given the nonrandomized nature, it is not known how these men would have fared according to survival or quality of life by observation, and/or other systemic therapy. Conclusions An optimal candidate for sLND tends to have pT2 at the original RP and a castration sensitive disease state. sLND could be considered part of a multimodal treatment approach in select patients with castrate-resistant prostate cancer in which delayed/reduced cancer progression could be achieved with a cytoreductive surgery. Patient summary We found that by performing a salvage lymph node dissection there are many men that can experience a biochemical response and eliminate further 11C-choline positron emission tomography/computed tomography radiographic recurrences.

KW - Biochemical recurrence

KW - Choline PET/CT

KW - Lymph node metastases

KW - Prostate cancers

KW - Recurrent prostate cancer

KW - Salvage lymph node dissection

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