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Wide heterogeneity is seen in node-positive prostate cancer post RP


"The biggest take home point is that patients with node-positive disease at the time of radical prostatectomy are a heterogeneous group of patients," says Daniel A. Triner, MD, PhD.

In this video, Daniel A. Triner, MD, PhD, shares the take-home message from 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.


What is the take-home message for the practicing urologist?

The biggest take home point is that patients with node-positive disease at the time of radical prostatectomy are a heterogeneous group of patients, and we need additional studies to identify which patients should receive secondary treatment and which type of secondary treatment they should receive. Additionally, patients who have a detectable PSA after prostatectomy and have node-positive disease are at very high risk for disease progression and development of metastases and observation in the setting really should be undertaken with caution and as part of shared decision-making. Lastly, it'll be interesting to see how management of these patients changes with increasing utilization and implementation of PSMA-PET as part of the preoperative workup for prostate cancer patients.

Is there anything you would like to add?

There's a randomized trial, NRG-GU008, ongoing in this space testing salvage radiation therapy with 2 years of GnRH-directed therapy compared with the same treatment plus 2 years of apalutamide in patients with node-positive disease at the time of prostatectomy, so it'll be exciting to see the results of this and how this might change our practice currently. Otherwise, I'd really just like to thank my mentor on this project, Dr. Todd Morgan, and the entire team at the Michigan Urological Surgery Improvement Collaborative. I'd also like to thank all of the patients and providers across music, who have really transformed the way we care for our neurological patients in the state of Michigan.

This transcription was edited for clarity.

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