Salvage lymph node dissection in nonmetastatic castration-resistant PCA.

[pjoshea13]

New Mayo study below [1].

"To evaluate oncologic outcomes of patients with nonmetastatic, castration-resistant prostate cancer treated with salvage lymph node dissection (sLND) or androgen-deprivation therapy (ADT) for lymph nodes (LN)-only recurrence."

"Mean PSA reduction was significantly higher after sLND than ADT (62.8% vs. 17.7% ...)."

"... there was a trend toward a longer time to {biochemical recurrence} (13.3 vs. 6 months ...) and {radiological recurrence} (21.1 vs. 14.2 months ...) in sLND patients than ADT..."

"... Median time to {second line systemic therapies} was longer in the sLND group than ADT ..)"

Conclusion: "In patients with nonmetastatic, castration-resistant prostate cancer, sLND resulted in greater PSA decrease than ADT. We noted a nonstatistically significant trend toward longer time to {biochemical recurrence} and longer time to {radiological recurrence} for patients treated with sLND than ADT. Additionally, sLND may increase time to {second line systemic therapies} as compared to ADT."

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/316...

Urol Oncol. 2019 Oct 22. pii: S1078-1439(19)30367-9. doi: 10.1016/j.urolonc.2019.09.016. [Epub ahead of print]

The role of salvage lymph node dissection in nonmetastatic castration-resistant prostate cancer: A single center experience.

Boeri L1, Sharma V2, Nehra A2, Kwon E2, Karnes RJ2.

Author information

1

Department of Urology, Mayo Clinic, Rochester, MN; Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: [e-mail].

2

Department of Urology, Mayo Clinic, Rochester, MN.

Abstract

OBJECTIVE:

To evaluate oncologic outcomes of patients with nonmetastatic, castration-resistant prostate cancer treated with salvage lymph node dissection (sLND) or androgen-deprivation therapy (ADT) for lymph nodes (LN)-only recurrence.

MATERIALS AND METHODS:

Retrospective analysis of 23 (51.1%) patients who underwent sLND and 22 (48.9%) men who received ADT for LN-only recurrence. Biochemical recurrence (BCR) was defined as prostate-specific antigen (PSA) >0.2 ng/ml with an increased trend and radiological recurrence (RAR) was defined as a positive imaging study after sLND or ADT. Second line systemic therapies (SST) were defined as any systemic therapy administered for progression. Predictors of BCR, RAR, and SST were assessed with Cox regression analyses.

RESULTS:

Mean PSA reduction was significantly higher after sLND than ADT (62.8% vs. 17.7%; P = 0.04). Clinical outcomes were not statistically different between the 2 groups. However, there was a trend toward a longer time to BCR (13.3 vs. 6 months; P = 0.2) and RAR (21.1 vs. 14.2 months, P = 0.09) in sLND patients than ADT. Median time to SST was longer in the sLND group than ADT (P = 0.04). Univariable Cox regression analyses showed that PSA doubling time and pT stage were associated with RAR and SST (all P < 0.05).

CONCLUSIONS:

In patients with nonmetastatic, castration-resistant prostate cancer, sLND resulted in greater PSA decrease than ADT. We noted a nonstatistically significant trend toward longer time to BCR and longer time to RAR for patients treated with sLND than ADT. Additionally, sLND may increase time to SST as compared to ADT.

Copyright © 2019 Elsevier Inc. All rights reserved.

KEYWORDS:

Androgen-deprivation therapy; Castration-resistant prostate cancer; Lymph nodes; Salvage lymph node dissection; Survival outcomes

PMID: 31653561 DOI: 10.1016/j.urolonc.2019.09.016

[Graham49]

Patrick

Given that it is castration resistant PCa isn't it fairly obvious that ADT would not be very effective and cutting out would be more effective? Or Am I misunderstanding the situation?

[pjoshea13 in reply to Graham49]

Graham,

Yes - CRPC implies first-line ADT failure in both arms of the study. So it seems that they compared surgery without ADT versus continuation of ADT.

I wonder what the mean time is between becoming CRPC & starting "second line systemic therapies".

-Patrick

[GP24]

In the full text they report that a mean of 4 affected lymph nodes were removed. This probably caused the drop in the PSA value.

Most non-metastatic CRPC patients show mets using a PSMA PET/CT:

urotoday.com/recent-abstrac...