PSA & PET Features to Select sLND Persons in Recurrent PCa

Article: https://www.physiciansweekly.com/psa-pet-features-to-select-slnd-persons-in-recurrent-pca

For a study, researchers sought to assess the association between pre-operative PSA value, 68Ga-prostate-specific-membrane-antigen (PSMA) PET performance, and oncologic results following salvage lymph node dissection (sLND) for biochemical recurrent prostate cancer (PCa).

In the analysis, 164 patients who had undergone pelvic±retroperitoneal sLND at 11 high-volume centers between 2012 and 2019 and had at least 2 pelvic lymph node recurrences of PCa were included. In terms of PSA readings at the time of sLND, pathologic results were divided into 4 categories: early (<0.5 ng/ml), low (0.5-0.99 ng/ml), moderate (1-1.5 ng/ml), and high (>1.5 ng/ml). Multivariable analyses were used to compute the clinical recurrence (CR)-free survival following sLND and display that data over the pre-operative PSA levels.

About 131 (80%) of the patients had one positive spot on the PET scan, and the median [interquartile range (IQR)] PSA at sLND was 1.1 (0.6, 2.0) ng/ml. All patients had a retroperitoneal dissection in addition to pelvic sLND, whereas 91 (55%) males did so. Around 15 (6, 28) was the median (IQR) number of nodes eliminated. As a function of pre-operative PSA value, the rate of positive pathology increased, with the greatest rates occurring in patients with pre-operative PSA values>1.5 ng/ml (pelvic-only sLNDs: 84%; pelvic + retroperitoneal sLNDs: 90%). After sLND, 67 (41%) males had PSA levels≤ 0.3 ng/ml. Pre-operative PSA was connected to PSA response in multivariable analysis (P<0.0001). Fifty-one CRs were recorded following sLND. After correcting for covariates, they discovered a strong, non-linear correlation between PSA level at sLND and the 12-month CR-free survival (P<0.0001), with patients who got sLND at PSA ≥1 ng/ml having the best likelihood of being free from CR.

Salvage surgery was done on males with PSA 1 ng/ml and was linked with the best short-term oncologic outcomes in cases with PET-detected nodal recurrences amenable to sLND. The findings may assist medical professionals in choosing the best time for 68Ga-PSMA PET in patients with biochemically recurrent PCa while awaiting confirmation from prospective studies.

Reference: bjui-journals.onlinelibrary.wiley.com/doi/10.1002/bco2.182

Dr. Rob’s comment

One approach in the treatment of prostate cancer for a disease reoccurrence after prostatectomy is salvage surgery, a second surgery which involves removing more lymph nodes. In this study, researchers looked at the success rates of salvage surgery from a number of different angles, including the role of gallium PSMA, a highly specific tumor imaging agent, in detecting lymph nodes with cancer cells, to guide the surgical planning. They found, at least in the short term (long term studies are pending), improved outcomes in keeping cancer under control with surgery guided by a PSMA PET/CT scan.

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