Back to overview

PCa Game changers: Limited versus extended PLND?

On day three of EAU24, the newest data comparing limited versus extended pelvic lymph node dissection (ePLND) in prostate cancer (PCa) was presented in the game changing session co-chaired by Prof. Joost Boormans (NL) and Prof. Jens Rassweiler (AT). This followed with a presentation of the latest real-world evidence from the Europa Uomo Prostate Partners’ Experience Research concerning quality of life (QoL) for patients and their partners.

Lymph node dissection in PCa: Is the book closed?

In his presentation ‘Pelvic lymph node dissection in prostate cancer: Update of the limited vs. extended randomised clinical trial’, Prof. Karim Touijer (US) shared promising follow-up data that illustrated ePLND did not change BCR but reduces two-year outcome metastases, particularly on distant metastasis in positive node + patients (pN+). His results illustrated therapeutic benefit of extended PLND.

According to Prof. Touijer, the effects of extended PLND were not explained by differences in time to salvage therapy, groups independent of number of nodes, and PSA persistent groups.

“How can LND reduce metastasis without affecting BCR?” asked Prof. Touijer. He suggests the tumour-self seeding hypothesis (Norton l, Massagué J. Nat Med 2006;12:875-8).

In Prof. Touijer’s opinion, patients undergoing radical prostatectomy should receive a PLND that includes external iliac, obturator fossa and hypogastric nodes. “Further research should examine biological mechanisms with respect to the anatomic location of affected nodes. Our clinically integrated trial design is adequate for conducting large, low-cost randomised trials.”

Discussant Prof. Freddie Hamdy (GB) provided two additional hypothesis that could possibly explain the findings of reduced metastases in the presence of N1 disease. Firstly, dormancy (Zarrer and Taipaleenmäi, J Bone Oncol 2024), and secondly, complex PCa phenotypes and genomic diversity (Rao et al, Genome Medicine, 2024).

Prof. Hamdy: “We need randomised clinical trials of lymphadenectomy versus no lymphadenectomy, using risk stratification tools with updated algorithms, imaging (PET), and intraoperative PSMA radioligand/NIR fluorescence, with hard outcomes.”

According to Prof. Hamdy, progression requires a deep dive into the genomics of PCa primary and metastases, and interface between metastatic/lethal clones in the primary tumour, lymph nodes and the bone marrow compartment.

In contrast to Prof. Touijer, Prof. Hamdy shared his opinion that pelvic lymphadenectomy should not be undertaken in every man who is a having a radical prostatectomy.

Living with a PCa patient

“PCa treatments have a substantial effect on the QoL of the partners”, stated Prof. André Deschamps (BE) in his presentation on the latest real-world evidence from the unprecedented Europa Uomo Prostate Cancer Partners Experience Research (EU-ProPER) study. There were 1,135 valid partners’ responses to the 20-minute online survey that included 80 questions.

Prof. Deschamps: “Approximately 83% of Pca patients are living with a partner. Cancer is often called the couples’ disease, and in this survey, we measured the effects on the QoL of the partners.”

Some of the significant findings according to Prof. Deschamps were that 1 in 6 partners were not aware of the consequences of the PCa treatment and partners reported a big gap between desired and given information. 32% reported an effect on their social life, and 19% had reduced their own social activities. Also, 46% reported PCa had an influence on their relationship (15-20% negatively, 43% positively).

Discussant Prof. Mieke Van Hemelrijck (GB) emphasised the importance of real-world evidence (RWE) to improve the understanding of health and social care delivery and experiences. “Communication is important, and the HCP recommends adopting a couple’s approach when managing PCa whenever there is a partner.”

To (re)watch the full presentations of this Plenary Session, please visit the EAU24 Resource Centre.