Mp14-15 Which Is the Optimal Multimodal Management of Pn1 Patients With Psa Persistence After Radical Prostatectomy and Extended Nodal Dissection? Results of a Large, Multi-Institutional Database

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) II (MP14)1 May 2024MP14-15 WHICH IS THE OPTIMAL MULTIMODAL MANAGEMENT OF PN1 PATIENTS WITH PSA PERSISTENCE AFTER RADICAL PROSTATECTOMY AND EXTENDED NODAL DISSECTION? RESULTS OF A LARGE, MULTI-INSTITUTIONAL DATABASE Simone Scuderi, Giancarlo Marra, Jonathan Olivier, Bartosz Malkiewicz, Armando Stabile, Elio Mazzone, Luca Afferi, Agostino Mattei, Sebastian Gallina, Alessandro Antonelli, Fabio Zattoni, Roderick van den Bergh, Pawel Rajwa, Shahrok F. Shariat, Xavier Cathelineau, Rossella Nicoletta, Riccardo Campi, Mohamed Ahmed, R. Jeffrey Karnes, Isabel Heidegger, Francesco Montorsi, Paolo Gontero, Alberto Briganti, and Giorgio Gandaglia Simone ScuderiSimone Scuderi , Giancarlo MarraGiancarlo Marra , Jonathan OlivierJonathan Olivier , Bartosz MalkiewiczBartosz Malkiewicz , Armando StabileArmando Stabile , Elio MazzoneElio Mazzone , Luca AfferiLuca Afferi , Agostino MatteiAgostino Mattei , Sebastian GallinaSebastian Gallina , Alessandro AntonelliAlessandro Antonelli , Fabio ZattoniFabio Zattoni , Roderick van den BerghRoderick van den Bergh , Pawel RajwaPawel Rajwa , Shahrok F. ShariatShahrok F. Shariat , Xavier CathelineauXavier Cathelineau , Rossella NicolettaRossella Nicoletta , Riccardo CampiRiccardo Campi , Mohamed AhmedMohamed Ahmed , R. Jeffrey KarnesR. Jeffrey Karnes , Isabel HeideggerIsabel Heidegger , Francesco MontorsiFrancesco Montorsi , Paolo GonteroPaolo Gontero , Alberto BrigantiAlberto Briganti , and Giorgio GandagliaGiorgio Gandaglia View All Author Informationhttps://doi.org/10.1097/01.JU.0001009428.69695.82.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Node positive (pN1) Prostate cancer (PCa) patients treated with radical prostatectomy (RP) exhibit adverse cancer control outcomes. Although selected pN1 patients should be managed with post-operative radiotherapy and androgen deprivation therapy (ADT) according to international guidelines, the setting of node positive patients with PSA persistence has not been assessed so far. METHODS: We relied on 660 pN1 PCa patients treated with RP and extended pelvic lymph node dissection (ePLND) at eleven referral centers between 2006 and 2021. PSA persistence was defined as a PSA≥0.1ng/ml at 6-week. All patients received salvage radiotherapy (sRT). Concomitant ADT at the time of sRT was defined as the administration of ADT within 3 months. Kaplan-Meier (KM) plots were used to depict overall-survival rates (OS). A multivariable logistic regression model based on the number of positive nodes, pT stage, PSA at persistence and ISUP GG was developed. An interaction term was used to test whether the risk of overall mortality (OM) determined by the regression model varies according to the timing of ADT administration. Finally, the observed vs. predicted OM-free survival was plotted for concomitant ADT vs. deferred ADT. RESULTS: The median number of preoperative PSA, positive nodes, age, and first PSA were 14 (9-27), 2 (1 - 3), 65 years (61 – 70, and 0.5 (0.2-1.7). Overall, 463 (71%) and 495 (75%) had pT3b/4 stage and ISUP GG 4-5 at RP, respectively. A total of 519 (79%) and 84 (13%) men received eADT vs deferred ADT. Median follow-up was 39 months. During the study period, a total of 67 patients experienced OM. The 10-years OS rate was 70%. At interaction analyses, the risk of OM varied according to the time at which ADT was administered in selected patients (p<0.05; Figure 1). Men with a 10-year OM risk higher than 60% according to the risk score are those that benefitted the most from the administration of concomitant ADT. CONCLUSIONS: Not all PCa patients with pN1 and PSA persistence after RP benefit the same from the concomitant administration of ADT at the time of sRT. The immediate use of ADT could be beneficial in patients with a predicted 10-years risk of death higher than 60% according to our model. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e226 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Simone Scuderi More articles by this author Giancarlo Marra More articles by this author Jonathan Olivier More articles by this author Bartosz Malkiewicz More articles by this author Armando Stabile More articles by this author Elio Mazzone More articles by this author Luca Afferi More articles by this author Agostino Mattei More articles by this author Sebastian Gallina More articles by this author Alessandro Antonelli More articles by this author Fabio Zattoni More articles by this author Roderick van den Bergh More articles by this author Pawel Rajwa More articles by this author Shahrok F. Shariat More articles by this author Xavier Cathelineau More articles by this author Rossella Nicoletta More articles by this author Riccardo Campi More articles by this author Mohamed Ahmed More articles by this author R. Jeffrey Karnes More articles by this author Isabel Heidegger More articles by this author Francesco Montorsi More articles by this author Paolo Gontero More articles by this author Alberto Briganti More articles by this author Giorgio Gandaglia More articles by this author Expand All Advertisement PDF downloadLoading ...