Salvage Surgery in Patients with Local Recurrence After Radical Prostatectomy

Knipper, Sophie; Ascalone, Luigi; Ziegler, Benjamin; Hohenhorst, Lukas; Simon, R.; Berliner, Christoph; Leeuwen, Fijs W. B. van; Poel, Henk van der; Giesel, Frederik L.; Graefen, Markus; Eiber, Matthias; Heck, Matthias; Horn, Thomas; Maurer, Tobias

doi:10.1016/j.eururo.2020.11.012

Cited by 26 publications

(10 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This therapeutic option could also be compared, or at least discussed, with other local salvage treatments. For instance, one study assessed the feasibility of salvage surgery, with a comparable median of biochemical recurrence-free survival of 23.7 months [29]. Another study reported the feasibility of brachytherapy with five patients, which is not enough to make conclusions on efficacy and safety [30].…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Re-Irradiation for Local Recurrence after Radical Prostatectomy and Radiation Therapy: A Retrospective Multicenter Study

Perennec

Vaugier

Tolédano

et al. 2021

Cancers

View full text Add to dashboard Cite

Prostate cancer recurrence in patients previously treated with radical prostatectomy and radiation therapy is challenging. Re-irradiation could be an option, but data regarding efficacy and safety are lacking. We retrospectively evaluated salvage re-irradiation for local recurrence after prostatectomy and external beam radiation therapy. We collected data from 48 patients who underwent salvage reirradiation with stereotactic radiation therapy for local prostate cancer recurrence in the prostatic bed at four French centers. Fifteen patients (31%) were on androgen deprivation therapy during stereotactic radiotherapy. Biochemical response and relapse-free survival were analyzed, and post-treatment toxicities were assessed according to the Common Terminology of Adverse Events criteria. Five patients had grade 3 late bladder toxicity (cystitis), three had grade 3 late incontinence, and one had grade 3 late chronic pain. At three months, 83% of patients had a positive biochemical response. The median follow-up was 22 months. At the end of the follow-up, 21 patients (43%) had a biochemical relapse. The median time to biologic relapse was 27 months. The biochemical relapse rates at 1 and 2 years were 80% and 52%, respectively. In conclusion, salvage re-irradiation for recurrent prostate cancer in the prostate bed may generate significant toxicity rates, and a prospective study with appropriate patient selection is needed to evaluate its effectiveness.

show abstract

Section: Discussionmentioning

confidence: 99%

Stereotactic Re-Irradiation for Local Recurrence after Radical Prostatectomy and Radiation Therapy: A Retrospective Multicenter Study

Perennec

Vaugier

Tolédano

et al. 2021

Cancers

View full text Add to dashboard Cite

show abstract

“…This type of dosing is considered favorable with regard to legislation and cost of toxicity studies (e.g., reduced chance of side effects). 99m Tc-PSMA I&S, in particular, has proven great potential in large patient groups for salvage nodal resection [ 10 ] and salvage surgery within the seminal vesicle bed [ 11 , 12 ]. In parallel, developments in medical devices [ 13 ] have made it possible to extend PSMA-targeted radioguided surgery from open to minimally invasive procedures such as robot-assisted radical prostatectomy (RARP) [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of fluorescence imaging at microdosing using a hybrid PSMA tracer during robot-assisted radical prostatectomy in a large animal model

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background With the rise of prostate-specific membrane antigen (PSMA) radioguided surgery, which is performed using a microdosing regime, demand for visual target confirmation via fluorescence guidance is growing. While proven very effective for radiotracers, microdosing approaches the detection limit for fluorescence imaging. Thus, utility will be highly dependent on the tracer performance, the sensitivity of the fluorescence camera used, and the degree of background signal. Using a porcine model the ability to perform robot-assisted radical prostatectomy under fluorescence guidance using the bimodal or rather hybrid PSMA tracer (99mTc-EuK-(SO3)Cy5-mas3) was studied, while employing the tracer in a microdosing regime. This was followed by ex vivo evaluation in surgical specimens obtained from prostate cancer patients. Results T50% blood and T50% urine were reached at 85 min and 390 min, in, respectively, blood and urine. Surgical fluorescence imaging allowed visualization of the prostate gland based on the basal PSMA-expression in porcine prostate. Together, in vivo visualization of the prostate and urinary excretion suggests at least an interval of > 7 h between tracer administration and surgery. Confocal microscopy of excised tissues confirmed tracer uptake in kidney and prostate, which was confirmed with PSMA IHC. No fluorescence was detected in other excised tissues. Tumor identification based on ex vivo fluorescence imaging of human prostate cancer specimens correlated with PSMA IHC. Conclusion Intraoperative PSMA-mediated fluorescence imaging with a microdosing approach was shown to be feasible. Furthermore, EuK‐(SO3)Cy5‐mas3 allowed tumor identification in human prostate samples, underlining the translational potential of this novel tracer. Trial registration Approval for use of biological material for research purposes was provided by the Translational Research Board of the Netherlands Cancer Institute-Antoni van Leeuwenhoek hospital (NKI-AvL) under reference IRBm19-273 (22/10/2019).

show abstract

“…In our cohort, we decided to exclude patients ongoing ADT, according to the previously performed clinical trial FALCON [ 19 ], in order to avoid a potential inference of anti-androgen treatment on 18 F-FACBC PET/CT’s DR. Second, histology was only available in a small number of papers as a standard of truth. However, it has to be underlined that biopsy for recurrence verification or histology after the “so-called” salvage-surgery is not common in clinical practice and is not exempt from controversy [ 25 ]; therefore, in real-life practice the reference is often represented by clinical evolution or confirmatory imaging.…”

Section: Discussionmentioning

confidence: 99%

Detection Rate and Clinical Impact of PET/CT with 18F-FACBC in Patients with Biochemical Recurrence of Prostate Cancer: A Retrospective Bicentric Study

et al. 2022

View full text Add to dashboard Cite

Our aim was to assess the detection rate (DR) of positron emission computed tomography (PET/CT) with anti-1-amino-3-[18F]-flurocyclobutane-1-carboxylic acid (18F-FACBC) in patients with biochemical recurrence (BCR) from prostate cancer (PC). As a secondary endpoint, we evaluated 18F-FACBC PET/CT’s impact on patients management. Clinical records of 81 patients submitted to 18F-FACBC PET/CT due to PC BCR in two Italian Nuclear Medicine Units were retrospectively assessed. DR was gauged in the whole cohort and stratifying patients by discrete intervals of PSA levels. PET/CT’s impact on clinical management was scored as (1) major if it entailed an intermodality change (e.g., from systemic to loco-regional therapy); (2) minor if it led to an intramodality change (e.g., modified radiotherapy field). PET/CT’s DR resulted in 76.9% in the whole cohort, with a positive predictive value of 96.7%. Stratified by PSA quartile intervals, PET/CT’s DR was 66.7%, 71.4%, 78.9% and 90% for PSA 0.2–0.57 ng/mL, 0.58–0.99 ng/mL, 1–1.5 ng/mL and >1.5 ng/mL without significant difference among groups (p = 0.81). The most common sites of relapse were prostate bed and pelvic lymph nodes (59.3%). PET/CT impacted on clinical management in 33/81 cases (40.7%), leading to a major change in 30 subjects (90.9%). 18F-FACBC PET/CT localized recurrence in patients with BCR, with meaningful DR also at low PSA levels and significantly impacted on clinical management.

show abstract

Salvage Surgery in Patients with Local Recurrence After Radical Prostatectomy

Cited by 26 publications

References 21 publications

Stereotactic Re-Irradiation for Local Recurrence after Radical Prostatectomy and Radiation Therapy: A Retrospective Multicenter Study

Stereotactic Re-Irradiation for Local Recurrence after Radical Prostatectomy and Radiation Therapy: A Retrospective Multicenter Study

Feasibility of fluorescence imaging at microdosing using a hybrid PSMA tracer during robot-assisted radical prostatectomy in a large animal model

Detection Rate and Clinical Impact of PET/CT with 18F-FACBC in Patients with Biochemical Recurrence of Prostate Cancer: A Retrospective Bicentric Study

Contact Info

Product

Resources

About