In:
World Journal of Urology, Springer Science and Business Media LLC, Vol. 41, No. 9 ( 2023-07-29), p. 2343-2350
Abstract:
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.
Type of Medium:
Online Resource
ISSN:
1433-8726
DOI:
10.1007/s00345-023-04534-5
Language:
English
Publisher:
Springer Science and Business Media LLC
Publication Date:
2023
detail.hit.zdb_id:
1463303-6
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