For a study, researchers sought to assess the association between pre-operative PSA value, 68Ga-prostate-specific-membrane-antigen (PSMA) PET performance, and oncologic results following salvage lymph node dissection (sLND) for biochemical recurrent prostate cancer (PCa).
In the analysis, 164 patients who had undergone pelvic±retroperitoneal sLND at 11 high-volume centers between 2012 and 2019 and had at least 2 pelvic lymph node recurrences of PCa were included. In terms of PSA readings at the time of sLND, pathologic results were divided into 4 categories: early (<0.5 ng/ml), low (0.5-0.99 ng/ml), moderate (1-1.5 ng/ml), and high (>1.5 ng/ml). Multivariable analyses were used to compute the clinical recurrence (CR)-free survival following sLND and display that data over the pre-operative PSA levels.
About 131 (80%) of the patients had one positive spot on the PET scan, and the median [interquartile range (IQR)] PSA at sLND was 1.1 (0.6, 2.0) ng/ml. All patients had a retroperitoneal dissection in addition to pelvic sLND, whereas 91 (55%) males did so. Around 15 (6, 28) was the median (IQR) number of nodes eliminated. As a function of pre-operative PSA value, the rate of positive pathology increased, with the greatest rates occurring in patients with pre-operative PSA values>1.5 ng/ml (pelvic-only sLNDs: 84%; pelvic + retroperitoneal sLNDs: 90%). After sLND, 67 (41%) males had PSA levels≤ 0.3 ng/ml. Pre-operative PSA was connected to PSA response in multivariable analysis (P<0.0001). Fifty-one CRs were recorded following sLND. After correcting for covariates, they discovered a strong, non-linear correlation between PSA level at sLND and the 12-month CR-free survival (P<0.0001), with patients who got sLND at PSA ≥1 ng/ml having the best likelihood of being free from CR.
Salvage surgery was done on males with PSA 1 ng/ml and was linked with the best short-term oncologic outcomes in cases with PET-detected nodal recurrences amenable to sLND. The findings may assist medical professionals in choosing the best time for 68Ga-PSMA PET in patients with biochemically recurrent PCa while awaiting confirmation from prospective studies.