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Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 7/2020

Open Access 01-07-2020 | Prostate Cancer | Original Article

PSMA-positive nodal recurrence in prostate cancer

Salvage radiotherapy is superior to salvage lymph node dissection in retrospective analysis

Authors: Dr. med. Nina-Sophie Schmidt-Hegemann, PD Dr. med. Alexander Buchner, Dr. med. Chukwuka Eze, Dr. med. Paul Rogowski, Christian Schaefer, Dr. med. Harun Ilhan, Dr. med. Minglun Li, PD Dr. med. Wolfgang Peter Fendler, Prof. Dr. med. Peter Bartenstein, Prof. Dr. med. Ute Ganswindt, Prof. Dr. med. Christian Stief, Prof. Dr. med. Claus Belka, PD Dr. med. Alexander Kretschmer

Published in: Strahlentherapie und Onkologie | Issue 7/2020

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Abstract

Purpose

This analysis compares salvage lymph node dissection (SLND) to salvage lymph node radiotherapy (SLNRT) of 68Ga-PSMA PET-positive nodal recurrences after radical prostatectomy (RPE).

Methods

A total of 67 SLNRT and 33 SLND consecutive patients with pelvic and/or para-aortic nodal recurrences after RPE were retrospectively analyzed. Biochemical recurrence-free survival rates (bRFS; PSA <0.2 ng/mL) were calculated according to Kaplan–Meier and survival curves were compared using the log rank test. For multivariable analysis, binary logistic regression analysis was performed (p < 0.05).

Results

Median follow-up was 17 months (range, 6–53 months) in SLND patients and 31 months (range, 3–56 months) in SLNRT patients (p = 0.027). SLNRT patients had significantly more tumours of pT3 and pT4 category (82% vs. 67%; p = 0.006), pathologically involved lymph nodes (45% vs. 27%; p = 0.001) and positive surgical margins (54% vs. 12%; p = 0.001) at time of RPE than SLND patients. PSA persistence after RPE was significantly more frequently observed in the SLNRT cohort (73% vs. 27%; p = 0.001). There was no significant difference in the distribution of PET-positive lymph nodes. Median PSA before SLND was higher than before SLNRT (3.07 ng/ml vs. 1.3 ng/ml; p = 0.393). The 2‑year bRFS was significantly higher in the SLNRT vs. the SLND cohort (92% vs. 30%; p = 0.001) with lower rates of distant metastases (21% vs. 52%; p = 0.002) and secondary treatments (5% vs. 39%; p = 0.011) irrespective of ongoing androgen deprivation therapy at last contact. In multivariable analysis, SLNRT was significantly associated with prolonged bRFS (regression coefficient 1.436, hazard ratio 4.204, 95% CI 1.789–9.878; p = 0.001).

Conclusion

Based on this retrospective study SLNRT might be the preferred treatment option for patients with nodal recurrence after previous RPE.
Appendix
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Metadata
Title
PSMA-positive nodal recurrence in prostate cancer
Salvage radiotherapy is superior to salvage lymph node dissection in retrospective analysis
Authors
Dr. med. Nina-Sophie Schmidt-Hegemann
PD Dr. med. Alexander Buchner
Dr. med. Chukwuka Eze
Dr. med. Paul Rogowski
Christian Schaefer
Dr. med. Harun Ilhan
Dr. med. Minglun Li
PD Dr. med. Wolfgang Peter Fendler
Prof. Dr. med. Peter Bartenstein
Prof. Dr. med. Ute Ganswindt
Prof. Dr. med. Christian Stief
Prof. Dr. med. Claus Belka
PD Dr. med. Alexander Kretschmer
Publication date
01-07-2020
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 7/2020
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-020-01605-z

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