PRESENTATION WITH LYMPHADENOPATHY

Theo M. de Reijke MD PhD FEBU

Department of Urology

Academic Medical Center

Amsterdam

SENSITIVITY 68GA- PSMA

RATIONALE FOR RRP IN N+ DISEASE

Prevention local problems

Better survival in limited N+ disease

Part of multimodal approach

NO prospective data!!

THERAPEUTIC RATIONALE FOR PLND

Breast cancer Mathiesen et al Acta Oncol 29:721-725, 1990

Gastric cancer Siewert et al Ann Surg 228:449-461, 1998

Gynecologic cancer Friedber Geburtshilfe Frauenheilk 49:423-427, 1989

Colorectal cancer Caplin et al Cancer 82:666-672, 1998

Bladder cancer Mills et al J Urol 166:19-23, 2001

Leissner et al BJU int 85:817-823, 2000

Konety et al J Urol 169:946-950, 2003

Retrospective studies demonstrated a

benefit of ePLND in terms of

biochemical recurrence-free survival,

as well as on disease progression and

long-term disease-free survival

IS THERE A THERAPEUTIC

BENEFIT OF EPLND?

Bader et al J Urol 169:849, 2003

Allaf et al J Urol 172:1840, 2004

Engel et al Eur Urol 57:754-761, 2010

PSA-PROGRESSION

FOLLOWING PLND IN PCA

Bader et al Eur Urol 3:55, 2004

Daneshmand et al J Urol 172:2252-2255, 2004

Frazier et al World J Urol 12:308-312, 1994

Allaf et al J Urol 172:1840-1844, 2004

Number of involved nodes is important

PFS: 70% with 1 or 2 positive nodes

49% with >5 positive nodes

Number of nodes removed is important

PD: 16% (0-4), 12% (5-9), 8% (10-14), 8%

(>14)

Briganti et al Eur Urol 55:261-270, 2009

Gakis et al Eur Urol 66:191-199,2014

Messing et al N Engl J Med 341:1781-1788, 1999

Messing et al Lancet Oncol 7:472-479, 2006

CONCLUSIONS

• Impact of LND on outcome remains

an open question

• Some studies report a beneficial effect

of LND on outcome

• Patients with low N postive burden

can be cured by local treatment

RECURENCE FOLLOWING RRP

Approximately 30% will develop

biochemical recurrence

Approximately 15% of patients will die

from prostate cancer

Identification of site of recurrence is

important

Local recurrence is usualy treated with

salvage EBRT

Distant recurrence is treated with ADT

(early or delayed)

RATIONALE FOR SURGICAL

TREATMENT OF LOCAL RECURRENCE.

Second chance for cure?

Other tumours (testis, renal, colon)

LOCAL RECURRENCE

FOLLOWING RRP - ??

Improved imaging modalities available

Real local recurrence

Pelvic recurrence in lymph node

Extra pelvic recurrence

Bone lesion

Rigatti et al Eur Urol 60:935-943, 2011

CONCLUSION

Pelvic lymph node recurrence: perhaps role for

surgery (or radiotherapy)

Extent of surgery/multimodality Tx??

Investigational new treatment approach, which

should be done within framework of trial

Decaestecker et al BMC Cancer 14:671, 2014

• Primary endpoint: androgen deprivation therapy-free survival• 6 Belgian hospitals are recruiting patients