Variability in treatment of node-positive prostate cancer after RP suggests QI opportunities

In this video, Daniel A. Triner, MD, PhD, discusses questions raised by the Urologic Oncology study “Variation in management of lymph node positive prostate cancer after radical prostatectomy within a statewide quality improvement consortium.” Triner is a urology resident at the University of Michigan in Ann Arbor.

Transcription:

What questions arise from this research?

One of the major questions that arises is for patients who do not have a detectable post prostatectomy PSA but have positive lymph nodes at the time of prostatectomy, we still do not truly know which patients should go on to receive secondary treatment or really what modality. As high as 30% of patients with node-positive disease will never have biochemical recurrence at 10 years after prostatectomy. So the question is, how can we identify these patients? Are there other biomarkers that may provide insights into their disease biology and tell us who should go on to receive secondary treatment? We also need more data on which modalities, such as ADT, RT, or a combination of the 2, is appropriate and for which patient. Along with that, there will surely be more questions that are going to arise with expanded use of PSMA-PET. We know that the sensitivity of PSMA-PET is higher than standard imaging, and false negatives on PSMA-PET are typically patients with lower nodal disease burden. So patients with a negative PSMA-PET may be a lower risk population compared to those who are positive with conventional staging imaging. Future studies of interest will be to look at long-term outcomes of patients staged as PSMA-PET negative but node positive on final pathology. And lastly, the wide variability that we found across MUSIC practices suggests an opportunity for us for quality improvement initiatives and additional evidence surrounding who should receive secondary treatment and what modalities, as I previously mentioned.

This transcription was edited for clarity.