Prevalence of bilateral loco-regional spread in unilateral pelvic PSMA PET positive recurrent prostate cancer
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Prevalence of bilateral loco-regional spread in unilateral pelvic PSMA PET positive recurrent prostate cancer. / Ambrosini, Francesca; Falkenbach, Fabian; Budaeus, Lars; Graefen, Markus; Koehler, Daniel; Lischewski, Flemming; Gschwend, Juergen E; Heck, Matthias; Eiber, Matthias; Knipper, Sophie; Maurer, Tobias.
In: MINERVA UROL NEPHROL, Vol. 75, No. 6, 12.2023, p. 734-742.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Prevalence of bilateral loco-regional spread in unilateral pelvic PSMA PET positive recurrent prostate cancer
AU - Ambrosini, Francesca
AU - Falkenbach, Fabian
AU - Budaeus, Lars
AU - Graefen, Markus
AU - Koehler, Daniel
AU - Lischewski, Flemming
AU - Gschwend, Juergen E
AU - Heck, Matthias
AU - Eiber, Matthias
AU - Knipper, Sophie
AU - Maurer, Tobias
PY - 2023/12
Y1 - 2023/12
N2 - BACKGROUND: Defining the best surgical template for salvage lymph node dissection (SLND) in patients exhibiting unilateral prostate cancer (PCa) recurrence in pelvic lymph nodes (LNs) is an unmet need. We assessed the risk of missing contralateral nodal recurrence in patients with unilateral positive PSMA-PET who were treated with bilateral PSMA-radioguided (RGS) SLND.METHODS: Patients who consecutively underwent bilateral PSMA-radioguided SLND for PCa recurrence between April 2014 and January 2023 were identified. We compared PSMA PET findings with the number and the location of PCa LN metastases of the final pathological report. Univariable logistic regression models to try to predict contralateral missed disease were performed.RESULTS: Sixty patients were identified. At PSMA-RGS, the median PSA level was 0.71 ng/mL (IQR: 0.38-2.28). At PSMA-PET pre-SLND, 49 (82%) patients had unilateral exclusively pelvic lesions, 2 (3%) had unilateral positive nodes at the level of the common iliac arteries, and 9 (15%) had unilateral positive nodes in both levels. Final pathology revealed unilateral LN involvement in 43 (72%), a negative report in 3 (5%), and bilateral positive lesions in 14 (23%) patients. In the univariable logistic regression models, none of the tested factors showed influence on missing contralateral lesions. Four patients out of 35 (11%) with one positive LN at PSMA-PET had bilateral PCa recurrence.CONCLUSIONS: Patients with one-sided positive LNs on PSMA PET can be considered for a unilateral PSMA-radioguided SLND template with the caveat that about a quarter of patients ultimately have bilateral positive LNs. Larger prospective randomized trials are needed to confirm our findings.
AB - BACKGROUND: Defining the best surgical template for salvage lymph node dissection (SLND) in patients exhibiting unilateral prostate cancer (PCa) recurrence in pelvic lymph nodes (LNs) is an unmet need. We assessed the risk of missing contralateral nodal recurrence in patients with unilateral positive PSMA-PET who were treated with bilateral PSMA-radioguided (RGS) SLND.METHODS: Patients who consecutively underwent bilateral PSMA-radioguided SLND for PCa recurrence between April 2014 and January 2023 were identified. We compared PSMA PET findings with the number and the location of PCa LN metastases of the final pathological report. Univariable logistic regression models to try to predict contralateral missed disease were performed.RESULTS: Sixty patients were identified. At PSMA-RGS, the median PSA level was 0.71 ng/mL (IQR: 0.38-2.28). At PSMA-PET pre-SLND, 49 (82%) patients had unilateral exclusively pelvic lesions, 2 (3%) had unilateral positive nodes at the level of the common iliac arteries, and 9 (15%) had unilateral positive nodes in both levels. Final pathology revealed unilateral LN involvement in 43 (72%), a negative report in 3 (5%), and bilateral positive lesions in 14 (23%) patients. In the univariable logistic regression models, none of the tested factors showed influence on missing contralateral lesions. Four patients out of 35 (11%) with one positive LN at PSMA-PET had bilateral PCa recurrence.CONCLUSIONS: Patients with one-sided positive LNs on PSMA PET can be considered for a unilateral PSMA-radioguided SLND template with the caveat that about a quarter of patients ultimately have bilateral positive LNs. Larger prospective randomized trials are needed to confirm our findings.
KW - Male
KW - Humans
KW - Prevalence
KW - Prospective Studies
KW - Neoplasm Recurrence, Local/diagnostic imaging
KW - Prostatic Neoplasms/diagnostic imaging
KW - Positron-Emission Tomography
U2 - 10.23736/S2724-6051.23.05445-9
DO - 10.23736/S2724-6051.23.05445-9
M3 - SCORING: Journal article
C2 - 38126286
VL - 75
SP - 734
EP - 742
JO - MINERVA UROL NEPHROL
JF - MINERVA UROL NEPHROL
SN - 2724-6051
IS - 6
ER -
