Dissecting the data.

Top Line: It’s great to be cured of biochemically recurrent prostate cancer with a pelvic lymph node dissection.
The Study: It’s not so great to undergo a pelvic lymph node dissection with no oncologic benefit. This retrospective look at 654 men with biochemical failures post-radical prostatectomy aimed to determine which characteristics are most associated with benefit from salvage node dissection. All men had isolated pelvic node recurrences on PSMA-PET. Failure to receive a benefit was viewed as an “early” clinical recurrence <1 year out from salvage dissection. Roughly a quarter of men experienced an early recurrence, and this, in turn, was associated with an over ten-fold increase in cancer mortality at 3 years. Significant predictors of early recurrence include a lot of what you might expect: grade group 5 (HR 2), receipt of ADT prior to recurrence (HR 1.5), ≥3 nodes involved (HR1.3), retroperitoneal nodal involvement (HR 1.2), and higher PSA at time of recurrence (in a continuous fashion). Seem difficult to translate into clinical decision making? They have nothing less than a risk calculator—albeit still in excel-file form buried in the supplementary material—soon to make it to an app store near you.
Bottom Line: Not all isolated radiographic prostate cancer nodal failures benefit from salvage node dissection, and now you have data (and excel formulas) to help you figure it out upfront. | Fossati, Eur Urol 2018


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