PRESENTATION WITH LYMPHADENOPATHY
Theo M. de Reijke MD PhD FEBU
Department of Urology
Academic Medical Center
Amsterdam
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
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)
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
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