Nodes ill.

Node-only recurrence of prostate cancer is tricky business. Here’s long term follow-up of one of the largest series to date on 189 men post-previous definitive prostatectomy undergoing salvage pelvic (+/- retroperitoneal) nodal dissection for node-only disease per PSMA or choline PET staging upon biochemical recurrence. Just over a third (n=69) of patients had a post-dissection PSA response and less than two-thirds (n=115) received ADT within 6 months of dissection. Ultimately, at 10 years, the chances of being free from subsequent biochemical recurrence was only 11% (median development at 22 months), free from mets 31%, and free from prostate cancer death 66% (the nearly exclusive reason for death here). Most importantly, if not surprisingly, those with a post-dissection PSA response (HR 0.45) as well as those receiving ADT within 6 months (HR 0.51) had lower risk of prostate cancer death on multivariate analysis. TBL: Node-only recurrence of prostate cancer needs systemic therapy. | Bravi, Eur Urol 2020

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