MP11-19 TARGETED LYMPH NODE DISSECTION AT RADIOTRACER-AVID SITES IN RECURRENT PROSTATE CANCER: AN EARLY ASSESSMENT OF EFFICACY (2018)

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II1 Apr 2018MP11-19 TARGETED LYMPH NODE DISSECTION AT RADIOTRACER-AVID SITES IN RECURRENT PROSTATE CANCER: AN EARLY ASSESSMENT OF EFFICACY Luke Shumaker, Clinton Bahler, Thomas Gardner, Michael Koch, and James Fletcher Luke ShumakerLuke Shumaker More articles by this author , Clinton BahlerClinton Bahler More articles by this author , Thomas GardnerThomas Gardner More articles by this author , Michael KochMichael Koch More articles by this author , and James FletcherJames Fletcher More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.385AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate-specific radiotracers have enabled PET studies to accurately identify lymph nodes (LN) harboring metastasis. We seek to provide early assessment regarding the efficacy of targeted LN dissections in recurrence. Our objective was to quantify PSA response and characterize the durability of initial trends. METHODS A population of 230 receiving a PET/CT was queried for post-scan targeted LN dissections. Cases with false positive scans by histology or where PSA trend-confounding hormonal therapy was applied were excluded. 23 patient courses were identified where targeted LN dissection was performed, prostatic adenocarcinoma was confirmed by histology, and sufficient follow up data was present. PSA trends were characterized and durability assessed by three primary metrics: initial change as a percent of pre-dissection PSA, time to recurrence of 100% pre-dissection PSA, 12 month PSA recurrent rates with recurrence defined as > 0.04 or > 0.2 ng / mL. RESULTS 19/23 achieved immediate down-trending PSA values confirmed by two results. 4/23 demonstrated a continued up-trend. 6/23 achieved immediately undetectable PSA (< 0.04 ng / mL) confirmed by two results. For the 19 with a down-trend, the average reduction as a percent of pre-dissection PSA was 82% with a range of 19.3 - 100%. In a subpopulation of 14 with initial down-trends, no hormonal therapy, and a minimum of 12 months follow up or recurrence sooner, the following observations were made regarding ≥100% pre-dissection PSA recurrence: 0 - 90 days: 2 recurred, 91 - 180: 0, 181 - 270: 1, 271 - 365: 2, 7 had not achieved ≥100% at 12 months and had no additional follow up data. 2 patients with long term follow up reached ≥100% at 612 and 743. Mann-Whitney testing was used to assess whether pre-dissection PSA correlated with likelihood of achieving a down-trend, undetectable PSA, or recurrence-free survival. No significant correlation was identified. CONCLUSIONS Targeted LN dissection offers some potential for durable, recurrence-free survival. However, ≥100% pre-dissection PSA recurrence is common. Achieving and maintaining a stable PSA long term is possible but unlikely. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e134 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Luke Shumaker More articles by this author Clinton Bahler More articles by this author Thomas Gardner More articles by this author Michael Koch More articles by this author James Fletcher More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...