AUA 2017: Robot-assisted Salvage Node Dissection for Oligometastatic Nodal Disease Detected by 68 Gallium-PSMA PET/CT: A Multicenter Retrospective Series

Boston, MA ( 68Ga PMSA PET/CT is a maturing, providing a potential mechanism for urologists and oncologists to more readily detect metastasis in patients with biochemical recurrence. In low volume node only metastatic disease, questions have been raised whether patients may benefit from salvage lymphadenectomy to delay systemic androgen deprivation therapy.

Over a two-year period, patients who underwent a robotic assisted salvage node dissection for oligometastatic nodal disease detected on PSMA from two centers were investigated to analyze safety and oncologic outcomes. 35 patients were included in analysis, with 58 total lesions on PSMA imaging. Median pre-salvage lymphadenectomy PSA was 2.2ng/ml and a median time from primary treatment of 61.3 months.

372 lymph nodes in total were excised. 91% of patients had positive pathology. 8 patients had post-operative complications, all of which were Clavien grade 1-2. Median follow up was 12 months. Biochemical free survival was 22.9% (defined as 6 weeks PSA<0.2 ng/ml) and median time to biochemical recurrence was 3.4 months. Clinical progression occurred in 34.3% of patients.

The group concludes that robotic assisted salvage node dissection is safe and feasible. However, long term studies are needed to better understand the oncologic benefits of this cohort. Currently, the benefit of the PSMA test compared to the surgical intervention alone remains unclear. At this time, salvage lymph node dissection should likely be done on clinical trial.

Authors: A Siriwardana, J Thompson, S Doig, P van Leeuwen, A Kalsbeek, L Emmett, W Delprado, H Samaratunga, AM Hayn

Presented by: Vincenzo Ficarra, MD

Written By: David B. Cahn, DO, MBS, Fox Chase Cancer Center, Philadelphia, PA
Twitter: @dbcahn

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA