MP67-11 REPEAT SALVAGE LYMPH NODE DISSECTION FOR RECURRENCE OF PROSTATE CANCER USING PSMA-RADIOGUIDANCE SURGERY (RGS) AFTER PRIOR SALVAGE LYMPH NODE DISSECTION WITH OR WITHOUT INITIAL RGS-SUPPORT

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP67-11 REPEAT SALVAGE LYMPH NODE DISSECTION FOR RECURRENCE OF PROSTATE CANCER USING PSMA-RADIOGUIDANCE SURGERY (RGS) AFTER PRIOR SALVAGE LYMPH NODE DISSECTION WITH OR WITHOUT INITIAL RGS-SUPPORT Fabian Falkenbach, Sophie Knipper, Daniel Koehler, Thomas Steuber, Markus Graefen, Lars Budäus, and Tobias Maurer Fabian FalkenbachFabian Falkenbach More articles by this author , Sophie KnipperSophie Knipper More articles by this author , Daniel KoehlerDaniel Koehler More articles by this author , Thomas SteuberThomas Steuber More articles by this author , Markus GraefenMarkus Graefen More articles by this author , Lars BudäusLars Budäus More articles by this author , and Tobias MaurerTobias Maurer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003330.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: With the advances of molecular PSMA PET imaging, metastasis directed therapy for low-PSA, recurrent locoregional metastatic prostate cancer after initial radical prostatectomy (RP) becomes more feasible. After initial salvage surgery patients (pts) with good response consider a secondary salvage surgery in case of progression and again circumscript prostate cancer lesion(s) on imaging. However, the oncologic outcome and safety profile of repeat PSMA-targeted radioguided surgery (RGS) after prior RGS or “standard” salvage lymph node dissection (sLND) remains unknown. METHODS: Within the prospectively collected clinical database of two tertiary care centers we identified 37 pts, who received a secondary RGS after prior sLND (n=21) or RGS (n=16) with or without prior pelvic radiation therapy between 2014 and 2021. Kaplan-Meier curves and uni-/multivariable Cox regression models were used to predict biochemical-recurrence free survival (BRFS) after the second salvage surgery. Histological correlation, time between first and second salvage surgery and Clavien-Dindo complications were evaluated. RESULTS: Median age at second salvage surgery was 70 years (IQR: 62-74y, RGS-RGS) or 69 years (IQR: 65-70y, sLND-RGS). Preoperative median PSA was 0.66 ng/ml (IQR: 0.42-1.3 ng/ml, RGS-RGS) or 1.16 (IQR: 0.89-2.25 ng/ml, sLND-RGS). In the univariable Cox regression model, age (HR 1.06), pN1 at RP (HR 2.72), preoperative PSA (HR 1.16), number of lesions on PSMA PET (HR 2.14) and retroperitoneal localization (HR 3,93 for combined pelvic and retroperitoneal lesions) were statistically significant predictors for shorter BRFS in the whole cohort (p<0.05). Time between first and second salvage surgery as well as the kind of first salvage surgery (RGS or sLND) were not statistically significant associated with an increased BRFS. Complete biochemical response (PSA<0.2 ng/ml) was seen in 62.5%. One year after secondary salvage surgery 89.2% did not receive additional treatment. Rate for major complications (Clavien-Dindo >3a) was 14% (3 pts) in the sLND-RGS group. There was no major complication in the RGS-RGS group. CONCLUSIONS: In selected cases, repeat RGS might delay the need for systemic treatment, while offering a reasonable safety profile. Especially in young patients with one pelvic recurrence and low PSA, second salvage surgery using RGS seems reasonable independent of time from initial RP or first salvage surgery. Limitations are the retrospective evaluation, heterogenous sLND procedures (mainly done in external hospitals) and lack of long follow up data, as well as the small cohort. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e947 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fabian Falkenbach More articles by this author Sophie Knipper More articles by this author Daniel Koehler More articles by this author Thomas Steuber More articles by this author Markus Graefen More articles by this author Lars Budäus More articles by this author Tobias Maurer More articles by this author Expand All Advertisement PDF downloadLoading ...