Prostate cancer: identifying optimal candidates for salvage LND

  • Fossati N & al.
  • Eur Urol
  • 6 Oct 2018

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Approximately 25% of patients with prostate cancer who undergo salvage lymph node dissection (SLND) for nodal recurrence after local treatment experience early clinical recurrence (eCR; ≤1 year).
  • A risk stratification tool based on preoperative characteristics can identify optimal candidates for SLND.

Why this matters

  • This tool can help avoid SLND in men likely to progress despite any imaging-guided approach.

Study design

  • 654 patients with prostate cancer underwent SLND after experiencing PSA rise and nodal recurrence after radical prostatectomy.
  • Funding: None.

Key results

  • Median follow-up was 30 months in patients without eCR.
  • 334 patients developed eCR.
  • Probability of eCR was 25%.
  • 3-year mortality rates were significantly higher in patients with eCR vs those without (20% vs 1.4%; P<.0001>
  • Significant predictors for eCR used for the model were:
    • Gleason grade group 5 (HR, 2.04; P<.0001>
    • time from surgery to PSA rising (HR, 0.99; P=.025),
    • hormonal therapy at PSA rise (HR, 1.47; P=.0005),
    • retroperitoneal uptake at positron emission tomography/computed tomography (PET/CT) scan (HR, 1.24; P=.038),
    • ≥3 positive spots at PET/CT scan (HR, 1.26; P=.019), and
    • PSA level at SLND (HR, 1.05; P<.0001>
  • The discrimination of the model (Harrel’s C-index) was 0.75; decision curve analysis showed higher clinical net-benefit vs "treat-all" option.

Limitations

  • Retrospective design.

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