MP15-10 THE ROLE OF LYMPH NODE DISSECTION IN PATIENTS UNDERGOING SALVAGE RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I (MP15)1 Sep 2021MP15-10 THE ROLE OF LYMPH NODE DISSECTION IN PATIENTS UNDERGOING SALVAGE RADICAL PROSTATECTOMY Fahad Quhal, Pawel Rajwa, Keiichiro Mori, Ekaterina Laukhtina, Nico C. Grossmann, Abdulmajeed Aydh, Reza Sari Motlagh, Satoshi Katayama, Hadi Mostafai, Benjamin Pradere, Paolo Gontero, Romain Mathieu, Pierre I. Karakiewicz, Alberto Briganti, Axel Heidenreich, and Shahrokh Shariat Fahad QuhalFahad Quhal More articles by this author , Pawel RajwaPawel Rajwa More articles by this author , Keiichiro MoriKeiichiro Mori More articles by this author , Ekaterina LaukhtinaEkaterina Laukhtina More articles by this author , Nico C. GrossmannNico C. Grossmann More articles by this author , Abdulmajeed AydhAbdulmajeed Aydh More articles by this author , Reza Sari MotlaghReza Sari Motlagh More articles by this author , Satoshi KatayamaSatoshi Katayama More articles by this author , Hadi MostafaiHadi Mostafai More articles by this author , Benjamin PradereBenjamin Pradere More articles by this author , Paolo GonteroPaolo Gontero More articles by this author , Romain MathieuRomain Mathieu More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Axel HeidenreichAxel Heidenreich More articles by this author , and Shahrokh ShariatShahrokh Shariat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001996.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate cancer (PCa) recurrence after primary radiotherapy is increasingly encountered. Radical prostatectomy is a salvage local treatment with potentially durable disease control for these patients. Here, we sought to examine the effect of lymph node dissection on the outcomes of patients with radiation-recurrent PCa who underwent salvage radical prostatectomy (SRP). METHODS: A retrospective review of patients with radiation-recurrent PCa who underwent SRP at six referral centers from 2000 to 2016. Recurrence after radiotherapy was defined as a prostate specific antigen (PSA) increase of ≥2 ng/mL above the nadir. All patients underwent a pre-SRP biopsy. Biochemical recurrence (BCR) was defined as PSA value of ≥0.2 ng/mL after SRP. The effect of the number of removed lymph nodes (RLNs) and positive lymph nodes (PLNs) on BCR-free survival, metastases free survival, overall survival (OS) was tested in multivariate Cox regression analyses. RESULTS: Overall, 334 patients underwent SRP and pelvic lymph node dissection. The median age and PSA at surgery were 68 years, and 3.55 ng/mL, respectively. The median follow up duration was 22.9 months (IQR 4.6-33.2) Lymph node involvement( LNI) was associated with increased risk of BCR (HR 2.18, p<0.001), metastasis (HR 3.93, p<0.001) and overall mortality (HR 2.88, p=0.006). In a multivariate cox regression analysis, an increased number of RLNs significantly reduced the risk of BCR (HR 0.96, p=0.01). In patients with positive lymph nodes, a higher number of RLN and a lower number of PLNs were both associated with improved freedom from BCR (HR 0.89, p= 0.001 and HR 1.34, p=0.008, respectively).The number of RLNs was not significantly associated with MFS. However, patients with ≥two positive lymph nodes were at a significantly increased risk of developing metastasis (HR 3.72, p=0.017). Neither the number of RLNs nor the number of PLNs were significantly associated with OS. In logistic regression analysis, an increased number of RLNs was associated with a higher probability of finding positive lymph nodes. CONCLUSIONS: LNI increased the risk of BCR, metastasis and overall mortality in radiation-recurrent PCa patients undergoing SRP. The increased number of RLNs improved staging through a higher probability of detecting LNI. Furthermore, an increased number of RLNs during SRP reduced the risk of BCR, hinting at a possible therapeutic benefit. However, further research with standardized lymph node templates is needed to support this conclusion and develop a precise therapeutic adjuvant strategy based on the number of RLNs and the number of PLNs. Source of Funding: No funding © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e267-e268 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fahad Quhal More articles by this author Pawel Rajwa More articles by this author Keiichiro Mori More articles by this author Ekaterina Laukhtina More articles by this author Nico C. Grossmann More articles by this author Abdulmajeed Aydh More articles by this author Reza Sari Motlagh More articles by this author Satoshi Katayama More articles by this author Hadi Mostafai More articles by this author Benjamin Pradere More articles by this author Paolo Gontero More articles by this author Romain Mathieu More articles by this author Pierre I. Karakiewicz More articles by this author Alberto Briganti More articles by this author Axel Heidenreich More articles by this author Shahrokh Shariat More articles by this author Expand All Advertisement Loading ...