TY  - JOUR
A1  - Falkenbach, Fabian
A1  - Knipper, Sophie
A1  - Koehler, Daniel
A1  - Ambrosini, Francesca
A1  - Steuber, Thomas
A1  - Graefen, Markus
A1  - Budäus, Lars
A1  - Eiber, Matthias
A1  - Lunger, Lukas
A1  - Lischewski, Flemming
A1  - Heck, Matthias M.
A1  - Maurer, Tobias
T1  - Safety and efficiency of repeat salvage lymph node dissection for recurrence of prostate cancer using PSMA-radioguided surgery (RGS) after prior salvage lymph node dissection with or without initial RGS support
T2  - World Journal of Urology
N2  - Background and objective: Metastasis-directed therapy is a feasible option for low PSA, recurrent locoregional metastatic prostate cancer. After initial salvage surgery, patients with good response might consider a repeat salvage surgery in case of recurrent, isolated, and PSMA-positive metastases. This analysis aimed to evaluate the oncological outcome and safety of repeat PSMA-targeted radioguided surgery (RGS) after either prior RGS or “standard” salvage lymph node dissection (SLND).

Materials and methods: We identified 37 patients undergoing repeat RGS after prior SLND (n = 21) (SLND-RGS) or prior RGS (n = 16) (RGS-RGS) between 2014 and 2021 after initial radical prostatectomy with or without pelvic radiation therapy at two German tertiary referral centers. Kaplan–Meier analyses and uni-/multivariable Cox regression models were used to investigate factors associated with biochemical recurrence-free survival (BRFS) and treatment-free survival (TFS) after repeat salvage surgery. 

Results and limitations: Complete Biochemical Response (cBR, PSA < 0.2 ng/ml) was observed in 20/32 patients (5 NA). Median overall BRFS [95% confidence interval (CI)] after repeat salvage surgery was 10.8 months (mo) (5.3–22). On multivariable regression, only age (HR 1.09, 95% CI 1.01–1.17) and preoperative PSA (HR 1.23, 95% CI 1.01–1.50) were associated with shorter BRFS, although PSA (HR 1.16, 95% CI 0.99–1.36) did not achieve significant predictor status in univariable analysis before (p value = 0.07). Overall, one year after second salvage surgery, 89% of the patients (number at risk: 19) did not receive additional treatment and median TFS was not reached. Clavien–Dindo grade > 3a complications were observed in 8% (3/37 patients). Limitations are the retrospective evaluation, heterogeneous SLND procedures, lack of long-term follow-up data, and small cohort size. 

Conclusion: In this study, repeat RGS was safe and provided clinically meaningful biochemical recurrence- and treatment-free intervals for selected cases. Patients having low preoperative PSA seemed to benefit most of repeat RGS, irrespective of prior SLND or RGS or the time from initial RP/first salvage surgery.
Y1  - 2023
UR  - https://opus.bibliothek.uni-augsburg.de/opus4/frontdoor/index/index/docId/124419
UR  - https://nbn-resolving.org/urn:nbn:de:bvb:384-opus4-1244194
SN  - 1433-8726
VL  - 41
IS  - 9
SP  - 2343
EP  - 2350
PB  - Springer Science and Business Media LLC
CY  - Berlin
ER  -