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Assessing the Best Surgical Template at Salvage Pelvic Lymph Node Dissection for Nodal Recurrence of Prostate Cancer After Radical Prostatectomy: When Can Bilateral Dissection be Omitted? Results from a Multi-institutional Series

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Assessing the Best Surgical Template at Salvage Pelvic Lymph Node Dissection for Nodal Recurrence of Prostate Cancer After Radical Prostatectomy: When Can Bilateral Dissection be Omitted? Results from a Multi-institutional Series. / Bravi, Carlo A; Fossati, Nicola; Gandaglia, Giorgio; Suardi, Nazareno; Mazzone, Elio; Robesti, Daniele; Osmonov, Daniar; Juenemann, Klaus-Peter; Boeri, Luca; Jeffrey Karnes, R; Kretschmer, Alexander; Buchner, Alexander; Stief, Christian; Hiester, Andreas; Nini, Alessandro; Albers, Peter; Devos, Gaëtan; Joniau, Steven; Van Poppel, Hendrik; Shariat, Shahrokh F; Heidenreich, Axel; Pfister, David; Tilki, Derya; Graefen, Markus; Gill, Inderbir S; Mottrie, Alexander; Karakiewicz, Pierre I; Montorsi, Francesco; Briganti, Alberto.

In: EUR UROL, Vol. 78, No. 6, 12.2020, p. 779-782.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Bravi, CA, Fossati, N, Gandaglia, G, Suardi, N, Mazzone, E, Robesti, D, Osmonov, D, Juenemann, K-P, Boeri, L, Jeffrey Karnes, R, Kretschmer, A, Buchner, A, Stief, C, Hiester, A, Nini, A, Albers, P, Devos, G, Joniau, S, Van Poppel, H, Shariat, SF, Heidenreich, A, Pfister, D, Tilki, D, Graefen, M, Gill, IS, Mottrie, A, Karakiewicz, PI, Montorsi, F & Briganti, A 2020, 'Assessing the Best Surgical Template at Salvage Pelvic Lymph Node Dissection for Nodal Recurrence of Prostate Cancer After Radical Prostatectomy: When Can Bilateral Dissection be Omitted? Results from a Multi-institutional Series', EUR UROL, vol. 78, no. 6, pp. 779-782. https://doi.org/10.1016/j.eururo.2020.06.047

APA

Bravi, C. A., Fossati, N., Gandaglia, G., Suardi, N., Mazzone, E., Robesti, D., Osmonov, D., Juenemann, K-P., Boeri, L., Jeffrey Karnes, R., Kretschmer, A., Buchner, A., Stief, C., Hiester, A., Nini, A., Albers, P., Devos, G., Joniau, S., Van Poppel, H., ... Briganti, A. (2020). Assessing the Best Surgical Template at Salvage Pelvic Lymph Node Dissection for Nodal Recurrence of Prostate Cancer After Radical Prostatectomy: When Can Bilateral Dissection be Omitted? Results from a Multi-institutional Series. EUR UROL, 78(6), 779-782. https://doi.org/10.1016/j.eururo.2020.06.047

Vancouver

Bravi CA, Fossati N, Gandaglia G, Suardi N, Mazzone E, Robesti D et al. Assessing the Best Surgical Template at Salvage Pelvic Lymph Node Dissection for Nodal Recurrence of Prostate Cancer After Radical Prostatectomy: When Can Bilateral Dissection be Omitted? Results from a Multi-institutional Series. EUR UROL. 2020 Dec;78(6):779-782. https://doi.org/10.1016/j.eururo.2020.06.047

Bibtex

@article{b5bfd9169c1b486da7503dda017ea231,
title = "Assessing the Best Surgical Template at Salvage Pelvic Lymph Node Dissection for Nodal Recurrence of Prostate Cancer After Radical Prostatectomy: When Can Bilateral Dissection be Omitted? Results from a Multi-institutional Series",
abstract = "The best surgical template for salvage pelvic lymph node dissection (sLND) in patients with nodal recurrence from prostate cancer (PCa) after radical prostatectomy (RP) is currently unknown. We analyzed data of 189 patients with a unilateral positive positron emission tomography (PET) scan of the pelvic lymph node areas, who were treated with bilateral pelvic sLND after RP at 11 high-volume centers. The primary endpoint was missed contralateral disease at final pathology, defined as lymph node positive for PCa in the side opposite to the positive spot(s) at the PET scan. Overall, 93 (49%) and 96 (51%) patients received a 11C-choline and a 68Ga prostate-specific membrane antigen (PSMA) PET scan, respectively, and 171 (90%) and 18 (10%) men had one and two positive spots, respectively. The rate of missed contralateral PCa was 18% (34/189), with the rates being 17% (29/171) and 28% (5/18) in men with one and two positive spots, respectively. While the rate of contralateral disease did not differ between 68Ga-PSMA and 11C-choline (29% and 27%, respectively) among men with two positive spots, the rate of contralateral PCa was only 6% with 68Ga-PSMA versus 28% with 11C-choline in patients with a single positive spot. This finding was confirmed at multivariable logistic regression analysis predicting missed disease at final pathology after accounting for confounders (odds ratio: 0.24; p =  0.001). However, in men with a single positive spot at 68Ga-PSMA PET/computed tomography, the rate of single confirmed lymph node metastasis at final pathology was only 33%, suggesting the need for extended template even if unilateral dissection is performed. Awaiting confirmatory studies, patients diagnosed with a single positive spot at the 68Ga-PSMA PET scan might be considered for unilateral extended pelvic sLND. PATIENT SUMMARY: We assessed the risk of missing contralateral disease in patients with a positron emission tomography (PET) scan suggestive of unilateral nodal recurrence from prostate cancer (PCa) after radical prostatectomy and who were treated with bilateral salvage lymph node dissection (sLND). Variability exists according to the number of positive spots and PET tracer, with the lowest rate of missed PCa in men diagnosed with a single positive spot at a 68Ga prostate-specific membrane antigen PET scan (6%). If replicated, our data suggest that these patients might be considered for unilateral extended pelvic sLND.",
author = "Bravi, {Carlo A} and Nicola Fossati and Giorgio Gandaglia and Nazareno Suardi and Elio Mazzone and Daniele Robesti and Daniar Osmonov and Klaus-Peter Juenemann and Luca Boeri and {Jeffrey Karnes}, R and Alexander Kretschmer and Alexander Buchner and Christian Stief and Andreas Hiester and Alessandro Nini and Peter Albers and Ga{\"e}tan Devos and Steven Joniau and {Van Poppel}, Hendrik and Shariat, {Shahrokh F} and Axel Heidenreich and David Pfister and Derya Tilki and Markus Graefen and Gill, {Inderbir S} and Alexander Mottrie and Karakiewicz, {Pierre I} and Francesco Montorsi and Alberto Briganti",
note = "Copyright {\textcopyright} 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.",
year = "2020",
month = dec,
doi = "10.1016/j.eururo.2020.06.047",
language = "English",
volume = "78",
pages = "779--782",
journal = "EUR UROL",
issn = "0302-2838",
publisher = "Elsevier",
number = "6",

}

RIS

TY - JOUR

T1 - Assessing the Best Surgical Template at Salvage Pelvic Lymph Node Dissection for Nodal Recurrence of Prostate Cancer After Radical Prostatectomy: When Can Bilateral Dissection be Omitted? Results from a Multi-institutional Series

AU - Bravi, Carlo A

AU - Fossati, Nicola

AU - Gandaglia, Giorgio

AU - Suardi, Nazareno

AU - Mazzone, Elio

AU - Robesti, Daniele

AU - Osmonov, Daniar

AU - Juenemann, Klaus-Peter

AU - Boeri, Luca

AU - Jeffrey Karnes, R

AU - Kretschmer, Alexander

AU - Buchner, Alexander

AU - Stief, Christian

AU - Hiester, Andreas

AU - Nini, Alessandro

AU - Albers, Peter

AU - Devos, Gaëtan

AU - Joniau, Steven

AU - Van Poppel, Hendrik

AU - Shariat, Shahrokh F

AU - Heidenreich, Axel

AU - Pfister, David

AU - Tilki, Derya

AU - Graefen, Markus

AU - Gill, Inderbir S

AU - Mottrie, Alexander

AU - Karakiewicz, Pierre I

AU - Montorsi, Francesco

AU - Briganti, Alberto

N1 - Copyright © 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.

PY - 2020/12

Y1 - 2020/12

N2 - The best surgical template for salvage pelvic lymph node dissection (sLND) in patients with nodal recurrence from prostate cancer (PCa) after radical prostatectomy (RP) is currently unknown. We analyzed data of 189 patients with a unilateral positive positron emission tomography (PET) scan of the pelvic lymph node areas, who were treated with bilateral pelvic sLND after RP at 11 high-volume centers. The primary endpoint was missed contralateral disease at final pathology, defined as lymph node positive for PCa in the side opposite to the positive spot(s) at the PET scan. Overall, 93 (49%) and 96 (51%) patients received a 11C-choline and a 68Ga prostate-specific membrane antigen (PSMA) PET scan, respectively, and 171 (90%) and 18 (10%) men had one and two positive spots, respectively. The rate of missed contralateral PCa was 18% (34/189), with the rates being 17% (29/171) and 28% (5/18) in men with one and two positive spots, respectively. While the rate of contralateral disease did not differ between 68Ga-PSMA and 11C-choline (29% and 27%, respectively) among men with two positive spots, the rate of contralateral PCa was only 6% with 68Ga-PSMA versus 28% with 11C-choline in patients with a single positive spot. This finding was confirmed at multivariable logistic regression analysis predicting missed disease at final pathology after accounting for confounders (odds ratio: 0.24; p =  0.001). However, in men with a single positive spot at 68Ga-PSMA PET/computed tomography, the rate of single confirmed lymph node metastasis at final pathology was only 33%, suggesting the need for extended template even if unilateral dissection is performed. Awaiting confirmatory studies, patients diagnosed with a single positive spot at the 68Ga-PSMA PET scan might be considered for unilateral extended pelvic sLND. PATIENT SUMMARY: We assessed the risk of missing contralateral disease in patients with a positron emission tomography (PET) scan suggestive of unilateral nodal recurrence from prostate cancer (PCa) after radical prostatectomy and who were treated with bilateral salvage lymph node dissection (sLND). Variability exists according to the number of positive spots and PET tracer, with the lowest rate of missed PCa in men diagnosed with a single positive spot at a 68Ga prostate-specific membrane antigen PET scan (6%). If replicated, our data suggest that these patients might be considered for unilateral extended pelvic sLND.

AB - The best surgical template for salvage pelvic lymph node dissection (sLND) in patients with nodal recurrence from prostate cancer (PCa) after radical prostatectomy (RP) is currently unknown. We analyzed data of 189 patients with a unilateral positive positron emission tomography (PET) scan of the pelvic lymph node areas, who were treated with bilateral pelvic sLND after RP at 11 high-volume centers. The primary endpoint was missed contralateral disease at final pathology, defined as lymph node positive for PCa in the side opposite to the positive spot(s) at the PET scan. Overall, 93 (49%) and 96 (51%) patients received a 11C-choline and a 68Ga prostate-specific membrane antigen (PSMA) PET scan, respectively, and 171 (90%) and 18 (10%) men had one and two positive spots, respectively. The rate of missed contralateral PCa was 18% (34/189), with the rates being 17% (29/171) and 28% (5/18) in men with one and two positive spots, respectively. While the rate of contralateral disease did not differ between 68Ga-PSMA and 11C-choline (29% and 27%, respectively) among men with two positive spots, the rate of contralateral PCa was only 6% with 68Ga-PSMA versus 28% with 11C-choline in patients with a single positive spot. This finding was confirmed at multivariable logistic regression analysis predicting missed disease at final pathology after accounting for confounders (odds ratio: 0.24; p =  0.001). However, in men with a single positive spot at 68Ga-PSMA PET/computed tomography, the rate of single confirmed lymph node metastasis at final pathology was only 33%, suggesting the need for extended template even if unilateral dissection is performed. Awaiting confirmatory studies, patients diagnosed with a single positive spot at the 68Ga-PSMA PET scan might be considered for unilateral extended pelvic sLND. PATIENT SUMMARY: We assessed the risk of missing contralateral disease in patients with a positron emission tomography (PET) scan suggestive of unilateral nodal recurrence from prostate cancer (PCa) after radical prostatectomy and who were treated with bilateral salvage lymph node dissection (sLND). Variability exists according to the number of positive spots and PET tracer, with the lowest rate of missed PCa in men diagnosed with a single positive spot at a 68Ga prostate-specific membrane antigen PET scan (6%). If replicated, our data suggest that these patients might be considered for unilateral extended pelvic sLND.

U2 - 10.1016/j.eururo.2020.06.047

DO - 10.1016/j.eururo.2020.06.047

M3 - SCORING: Journal article

C2 - 32624281

VL - 78

SP - 779

EP - 782

JO - EUR UROL

JF - EUR UROL

SN - 0302-2838

IS - 6

ER -