TY - JOUR
T1 - Standard of Care Versus Metastases-directed Therapy for PET-detected Nodal Oligorecurrent Prostate Cancer Following Multimodality Treatment
T2 - A Multi-institutional Case-control Study
AU - Steuber, T.
AU - Jilg, C.
AU - Tennstedt, P.
AU - De Bruycker, A.
AU - Tilki, D.
AU - Decaestecker, K.
AU - Zilli, T.
AU - Jereczek-Fossa, B. A.
AU - Wetterauer, U.
AU - Grosu, A. L.
AU - Schultze-Seemann, W.
AU - Heinzer, H.
AU - Graefen, M.
AU - Morlacco, A.
AU - Karnes, R. J.
AU - Ost, P.
N1 - Publisher Copyright:
© 2018 European Association of Urology
PY - 2019/11
Y1 - 2019/11
N2 - Background: Most prostate cancer (PCa) patients with a biochemical failure following primary multimodality treatment (surgery and postoperative radiotherapy) relapse in the nodes. Objective: To perform a matched-case analysis in men with lymph node recurrent PCa comparing standard of care (SOC) with metastasis-directed therapy (MDT). Design, setting, and participants: PCa patients with a prostate-specific antigen (PSA) progression following multimodality treatment were included in this retrospective multi-institutional analysis. Intervention: The SOC cohort (n = 1816) received immediate or delayed androgen deprivation therapy administered at PSA progression. The MDT cohort (n = 263) received either salvage lymph node dissection (n = 166) or stereotactic body radiotherapy (n = 97) at PSA progression to a positron emission tomography-detected nodal recurrence. Outcome measurements and statistical analysis: The primary endpoint, cancer-specific survival (CSS), was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched analyses. Results and limitations: At a median follow-up of 70 (interquartile range: 48–98) mo, MDT was associated with an improved CSS on univariate (p = 0.029) and multivariate analysis (hazard ratio: 0.33, 95% confidence interval [CI]: 0.17–0.64) adjusted for the year of radical prostatectomy (RP), age at RP, PSA at RP, time from RP to PSA progression, Gleason score, surgical margin status, pT- and pN-stage. In total, 659 men were matched (3:1 ratio). The 5-yr CSS was 98.6% (95% CI: 94.3–99.6) and 95.7% (95% CI: 93.2–97.3) for MDT and SOC, respectively (p = 0.005, log-rank). The main limitations of our study are its retrospective design and lack of standardization of systemic treatment in the SOC cohort. Conclusions: MDT for nodal oligorecurrent PCa improves CSS as compared with SOC. These retrospective data from a multi-institutional pooled analysis should be considered as hypothesis-generating and inform future randomized trials in this setting. Patient summary: Prostate cancer patients experiencing a lymph node recurrence might benefit from local treatments directed at these lymph nodes.
AB - Background: Most prostate cancer (PCa) patients with a biochemical failure following primary multimodality treatment (surgery and postoperative radiotherapy) relapse in the nodes. Objective: To perform a matched-case analysis in men with lymph node recurrent PCa comparing standard of care (SOC) with metastasis-directed therapy (MDT). Design, setting, and participants: PCa patients with a prostate-specific antigen (PSA) progression following multimodality treatment were included in this retrospective multi-institutional analysis. Intervention: The SOC cohort (n = 1816) received immediate or delayed androgen deprivation therapy administered at PSA progression. The MDT cohort (n = 263) received either salvage lymph node dissection (n = 166) or stereotactic body radiotherapy (n = 97) at PSA progression to a positron emission tomography-detected nodal recurrence. Outcome measurements and statistical analysis: The primary endpoint, cancer-specific survival (CSS), was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched analyses. Results and limitations: At a median follow-up of 70 (interquartile range: 48–98) mo, MDT was associated with an improved CSS on univariate (p = 0.029) and multivariate analysis (hazard ratio: 0.33, 95% confidence interval [CI]: 0.17–0.64) adjusted for the year of radical prostatectomy (RP), age at RP, PSA at RP, time from RP to PSA progression, Gleason score, surgical margin status, pT- and pN-stage. In total, 659 men were matched (3:1 ratio). The 5-yr CSS was 98.6% (95% CI: 94.3–99.6) and 95.7% (95% CI: 93.2–97.3) for MDT and SOC, respectively (p = 0.005, log-rank). The main limitations of our study are its retrospective design and lack of standardization of systemic treatment in the SOC cohort. Conclusions: MDT for nodal oligorecurrent PCa improves CSS as compared with SOC. These retrospective data from a multi-institutional pooled analysis should be considered as hypothesis-generating and inform future randomized trials in this setting. Patient summary: Prostate cancer patients experiencing a lymph node recurrence might benefit from local treatments directed at these lymph nodes.
KW - Choline PET/CT
KW - Neoplasm metastasis
KW - Neoplasm recurrence
KW - Oligometastasis
KW - Prostatic neoplasms
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U2 - 10.1016/j.euf.2018.02.015
DO - 10.1016/j.euf.2018.02.015
M3 - Article
C2 - 29530632
AN - SCOPUS:85043254574
SN - 2405-4569
VL - 5
SP - 1007
EP - 1013
JO - European Urology Focus
JF - European Urology Focus
IS - 6
ER -