Standard of Care Versus Metastases-directed Therapy for PET-detected Nodal Oligorecurrent Prostate Cancer Following Multimodality Treatment: A Multi-institutional Case-control Study

T. Steuber, C. Jilg, P. Tennstedt, A. De Bruycker, K. Decaestecker, T. Zilli, B. A. Jereczek-Fossa, U. Wetterauer, A. L. Grosu, W. Schultze-Seemann, H. Heinzer, M. Graefen, A. Morlacco, R. J. Karnes, Piet Ost

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Most prostate cancer (PCa) patients with a biochemical failure following primary multimodality treatment (surgery and postoperative radiotherapy) relapse in the nodes. Objective: To perform a matched-case analysis in men with lymph node recurrent PCa comparing standard of care (SOC) with metastasis-directed therapy (MDT). Design, setting, and participants: PCa patients with a prostate-specific antigen (PSA) progression following multimodality treatment were included in this retrospective multi-institutional analysis. Intervention: The SOC cohort (n = 1816) received immediate or delayed androgen deprivation therapy administered at PSA progression. The MDT cohort (n = 263) received either salvage lymph node dissection (n = 166) or stereotactic body radiotherapy (n = 97) at PSA progression to a positron emission tomography-detected nodal recurrence. Outcome measurements and statistical analysis: The primary endpoint, cancer-specific survival (CSS), was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched analyses. Results and limitations: At a median follow-up of 70 (interquartile range: 48-98) mo, MDT was associated with an improved CSS on univariate (p = 0.029) and multivariate analysis (hazard ratio: 0.33, 95% confidence interval [CI]: 0.17-0.64) adjusted for the year of radical prostatectomy (RP), age at RP, PSA at RP, time from RP to PSA progression, Gleason score, surgical margin status, pT- and pN-stage. In total, 659 men were matched (3:1 ratio). The 5-yr CSS was 98.6% (95% CI: 94.3-99.6) and 95.7% (95% CI: 93.2-97.3) for MDT and SOC, respectively (p = 0.005, log-rank). The main limitations of our study are its retrospective design and lack of standardization of systemic treatment in the SOC cohort. Conclusions: MDT for nodal oligorecurrent PCa improves CSS as compared with SOC. These retrospective data from a multi-institutional pooled analysis should be considered as hypothesis-generating and inform future randomized trials in this setting. Patient summary: Prostate cancer patients experiencing a lymph node recurrence might benefit from local treatments directed at these lymph nodes. Most prostate cancer patients with a biochemical failure following primary multimodality treatment (surgery and postoperative radiotherapy) relapse in the nodes. Metastasis-directed therapy for these nodal recurrences might improve cancer-specific survival as compared with standard of care treatment.

Original languageEnglish (US)
JournalEuropean Urology Focus
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Standard of Care
Case-Control Studies
Prostatic Neoplasms
Neoplasm Metastasis
Prostate-Specific Antigen
Prostatectomy
Therapeutics
Recurrence
Survival
Lymph Nodes
Confidence Intervals
Neoplasms
Radiotherapy
Propensity Score
Radiosurgery
Neoplasm Grading
Lymph Node Excision
Proportional Hazards Models
Positron-Emission Tomography
Androgens

Keywords

  • Choline PET/CT
  • Neoplasm metastasis
  • Neoplasm recurrence
  • Oligometastasis
  • Prostatic neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

Standard of Care Versus Metastases-directed Therapy for PET-detected Nodal Oligorecurrent Prostate Cancer Following Multimodality Treatment : A Multi-institutional Case-control Study. / Steuber, T.; Jilg, C.; Tennstedt, P.; De Bruycker, A.; Decaestecker, K.; Zilli, T.; Jereczek-Fossa, B. A.; Wetterauer, U.; Grosu, A. L.; Schultze-Seemann, W.; Heinzer, H.; Graefen, M.; Morlacco, A.; Karnes, R. J.; Ost, Piet.

In: European Urology Focus, 01.01.2018.

Research output: Contribution to journalArticle

Steuber, T, Jilg, C, Tennstedt, P, De Bruycker, A, Decaestecker, K, Zilli, T, Jereczek-Fossa, BA, Wetterauer, U, Grosu, AL, Schultze-Seemann, W, Heinzer, H, Graefen, M, Morlacco, A, Karnes, RJ & Ost, P 2018, 'Standard of Care Versus Metastases-directed Therapy for PET-detected Nodal Oligorecurrent Prostate Cancer Following Multimodality Treatment: A Multi-institutional Case-control Study', European Urology Focus. https://doi.org/10.1016/j.euf.2018.02.015
Steuber, T. ; Jilg, C. ; Tennstedt, P. ; De Bruycker, A. ; Decaestecker, K. ; Zilli, T. ; Jereczek-Fossa, B. A. ; Wetterauer, U. ; Grosu, A. L. ; Schultze-Seemann, W. ; Heinzer, H. ; Graefen, M. ; Morlacco, A. ; Karnes, R. J. ; Ost, Piet. / Standard of Care Versus Metastases-directed Therapy for PET-detected Nodal Oligorecurrent Prostate Cancer Following Multimodality Treatment : A Multi-institutional Case-control Study. In: European Urology Focus. 2018.
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title = "Standard of Care Versus Metastases-directed Therapy for PET-detected Nodal Oligorecurrent Prostate Cancer Following Multimodality Treatment: A Multi-institutional Case-control Study",
abstract = "Background: Most prostate cancer (PCa) patients with a biochemical failure following primary multimodality treatment (surgery and postoperative radiotherapy) relapse in the nodes. Objective: To perform a matched-case analysis in men with lymph node recurrent PCa comparing standard of care (SOC) with metastasis-directed therapy (MDT). Design, setting, and participants: PCa patients with a prostate-specific antigen (PSA) progression following multimodality treatment were included in this retrospective multi-institutional analysis. Intervention: The SOC cohort (n = 1816) received immediate or delayed androgen deprivation therapy administered at PSA progression. The MDT cohort (n = 263) received either salvage lymph node dissection (n = 166) or stereotactic body radiotherapy (n = 97) at PSA progression to a positron emission tomography-detected nodal recurrence. Outcome measurements and statistical analysis: The primary endpoint, cancer-specific survival (CSS), was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched analyses. Results and limitations: At a median follow-up of 70 (interquartile range: 48-98) mo, MDT was associated with an improved CSS on univariate (p = 0.029) and multivariate analysis (hazard ratio: 0.33, 95{\%} confidence interval [CI]: 0.17-0.64) adjusted for the year of radical prostatectomy (RP), age at RP, PSA at RP, time from RP to PSA progression, Gleason score, surgical margin status, pT- and pN-stage. In total, 659 men were matched (3:1 ratio). The 5-yr CSS was 98.6{\%} (95{\%} CI: 94.3-99.6) and 95.7{\%} (95{\%} CI: 93.2-97.3) for MDT and SOC, respectively (p = 0.005, log-rank). The main limitations of our study are its retrospective design and lack of standardization of systemic treatment in the SOC cohort. Conclusions: MDT for nodal oligorecurrent PCa improves CSS as compared with SOC. These retrospective data from a multi-institutional pooled analysis should be considered as hypothesis-generating and inform future randomized trials in this setting. Patient summary: Prostate cancer patients experiencing a lymph node recurrence might benefit from local treatments directed at these lymph nodes. Most prostate cancer patients with a biochemical failure following primary multimodality treatment (surgery and postoperative radiotherapy) relapse in the nodes. Metastasis-directed therapy for these nodal recurrences might improve cancer-specific survival as compared with standard of care treatment.",
keywords = "Choline PET/CT, Neoplasm metastasis, Neoplasm recurrence, Oligometastasis, Prostatic neoplasms",
author = "T. Steuber and C. Jilg and P. Tennstedt and {De Bruycker}, A. and K. Decaestecker and T. Zilli and Jereczek-Fossa, {B. A.} and U. Wetterauer and Grosu, {A. L.} and W. Schultze-Seemann and H. Heinzer and M. Graefen and A. Morlacco and Karnes, {R. J.} and Piet Ost",
year = "2018",
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day = "1",
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language = "English (US)",
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TY - JOUR

T1 - Standard of Care Versus Metastases-directed Therapy for PET-detected Nodal Oligorecurrent Prostate Cancer Following Multimodality Treatment

T2 - A Multi-institutional Case-control Study

AU - Steuber, T.

AU - Jilg, C.

AU - Tennstedt, P.

AU - De Bruycker, A.

AU - Decaestecker, K.

AU - Zilli, T.

AU - Jereczek-Fossa, B. A.

AU - Wetterauer, U.

AU - Grosu, A. L.

AU - Schultze-Seemann, W.

AU - Heinzer, H.

AU - Graefen, M.

AU - Morlacco, A.

AU - Karnes, R. J.

AU - Ost, Piet

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Most prostate cancer (PCa) patients with a biochemical failure following primary multimodality treatment (surgery and postoperative radiotherapy) relapse in the nodes. Objective: To perform a matched-case analysis in men with lymph node recurrent PCa comparing standard of care (SOC) with metastasis-directed therapy (MDT). Design, setting, and participants: PCa patients with a prostate-specific antigen (PSA) progression following multimodality treatment were included in this retrospective multi-institutional analysis. Intervention: The SOC cohort (n = 1816) received immediate or delayed androgen deprivation therapy administered at PSA progression. The MDT cohort (n = 263) received either salvage lymph node dissection (n = 166) or stereotactic body radiotherapy (n = 97) at PSA progression to a positron emission tomography-detected nodal recurrence. Outcome measurements and statistical analysis: The primary endpoint, cancer-specific survival (CSS), was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched analyses. Results and limitations: At a median follow-up of 70 (interquartile range: 48-98) mo, MDT was associated with an improved CSS on univariate (p = 0.029) and multivariate analysis (hazard ratio: 0.33, 95% confidence interval [CI]: 0.17-0.64) adjusted for the year of radical prostatectomy (RP), age at RP, PSA at RP, time from RP to PSA progression, Gleason score, surgical margin status, pT- and pN-stage. In total, 659 men were matched (3:1 ratio). The 5-yr CSS was 98.6% (95% CI: 94.3-99.6) and 95.7% (95% CI: 93.2-97.3) for MDT and SOC, respectively (p = 0.005, log-rank). The main limitations of our study are its retrospective design and lack of standardization of systemic treatment in the SOC cohort. Conclusions: MDT for nodal oligorecurrent PCa improves CSS as compared with SOC. These retrospective data from a multi-institutional pooled analysis should be considered as hypothesis-generating and inform future randomized trials in this setting. Patient summary: Prostate cancer patients experiencing a lymph node recurrence might benefit from local treatments directed at these lymph nodes. Most prostate cancer patients with a biochemical failure following primary multimodality treatment (surgery and postoperative radiotherapy) relapse in the nodes. Metastasis-directed therapy for these nodal recurrences might improve cancer-specific survival as compared with standard of care treatment.

AB - Background: Most prostate cancer (PCa) patients with a biochemical failure following primary multimodality treatment (surgery and postoperative radiotherapy) relapse in the nodes. Objective: To perform a matched-case analysis in men with lymph node recurrent PCa comparing standard of care (SOC) with metastasis-directed therapy (MDT). Design, setting, and participants: PCa patients with a prostate-specific antigen (PSA) progression following multimodality treatment were included in this retrospective multi-institutional analysis. Intervention: The SOC cohort (n = 1816) received immediate or delayed androgen deprivation therapy administered at PSA progression. The MDT cohort (n = 263) received either salvage lymph node dissection (n = 166) or stereotactic body radiotherapy (n = 97) at PSA progression to a positron emission tomography-detected nodal recurrence. Outcome measurements and statistical analysis: The primary endpoint, cancer-specific survival (CSS), was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched analyses. Results and limitations: At a median follow-up of 70 (interquartile range: 48-98) mo, MDT was associated with an improved CSS on univariate (p = 0.029) and multivariate analysis (hazard ratio: 0.33, 95% confidence interval [CI]: 0.17-0.64) adjusted for the year of radical prostatectomy (RP), age at RP, PSA at RP, time from RP to PSA progression, Gleason score, surgical margin status, pT- and pN-stage. In total, 659 men were matched (3:1 ratio). The 5-yr CSS was 98.6% (95% CI: 94.3-99.6) and 95.7% (95% CI: 93.2-97.3) for MDT and SOC, respectively (p = 0.005, log-rank). The main limitations of our study are its retrospective design and lack of standardization of systemic treatment in the SOC cohort. Conclusions: MDT for nodal oligorecurrent PCa improves CSS as compared with SOC. These retrospective data from a multi-institutional pooled analysis should be considered as hypothesis-generating and inform future randomized trials in this setting. Patient summary: Prostate cancer patients experiencing a lymph node recurrence might benefit from local treatments directed at these lymph nodes. Most prostate cancer patients with a biochemical failure following primary multimodality treatment (surgery and postoperative radiotherapy) relapse in the nodes. Metastasis-directed therapy for these nodal recurrences might improve cancer-specific survival as compared with standard of care treatment.

KW - Choline PET/CT

KW - Neoplasm metastasis

KW - Neoplasm recurrence

KW - Oligometastasis

KW - Prostatic neoplasms

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