Extended vs. No Pelvic Lymph Node Dissection During Radical Prostatectomy. DISSECTION 2.0.

University Hospital, Basel, Switzerland400 enrolled

Overview

The aim of the DISSECTION 2.0 study is to determine whether extended pelvic lymph node dissection (ePLND) provides a therapeutic benefit for high-risk prostate cancer patients by improving cancer staging and potentially removing micrometastatic disease, ultimately improving their outcomes.

Prostate cancer is the second most common cancer in men globally and a major cause of cancer deaths in Europe. For men with localized prostate cancer (PCa) and a life expectancy of over 10 years, radical prostatectomy (RP) is the standard treatment. It improves survival compared to conservative management. However, there is debate about de benefit of pelvic lymph node dissection (PLND), the removal of lymph nodes in the pelvis, during RP. While PLND can be omitted in low risk PCa patients, extended PLND (ePLND) is recommended in PCa patients at high-risk for recurrence in order to improve nodal staging The DISSECTION 2.0 study aims to investigate whether extended PLND (ePLND) provides additional benefits for men with high-risk PCa. The hypothesis is that ePLND might help by removing undetectable cancer cells (micrometastases) in the lymph nodes or by better staging the disease for treatment planning. While imaging techniques like PSMA-PET are good at detecting cancer spread, they still miss approximately 60% of cancer-bearing lymph nodes, leaving room for ePLND to potentially improve outcomes. ePLND involves removing more lymph nodes than standard PLND, leading to better detection of cancer spread. However, it also increases surgery time and complications slightly, though serious complications are rare.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

400

Conditions

Prostate Cancer Surgery Prostate Cancers

Interventions

Extended Pelvic Lymph Node DissectionPROCEDURE

Extended pelvic lymph node dissection during radical prostatectomy

Eligibility

Sex: MALEMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age ≥ 18 years and life expectancy \>15 years * Any biopsy-proven WHO/ISUP grade groups III-V PCa * High-risk prostate cancer defined as: * Any biopsy-proven WHO/ISUP grade group III-V PCa or * ISUP grade group II and PSA \> 20 ng/ml * PSMA-PET: negative staging for regional and distant metastasis * multidisciplinary tumorboard recommendation for radical prostatectomy * WHO performance status 0-1 * Adequate condition (ASA ≤ III) for general anesthesia and RP Exclusion Criteria: * ISUP grade group I PCa and cT1 or cT2 (MRI) * cT4 (MRI) PCa * PSMA-PET: positive staging for local and distant metastasis * Any prior neoadjuvant, local or systemic treatment for PCa * Previous PLND or pelvic radiotherapy * Patients with a prior malignancy and treated with curative intention are eligible if all treatment of that malignancy was completed at least 2 years before registration and the patient has no evidence of disease at registration. Less than 2 years is acceptable for malignancies with low risk of recurrence and/or no late recurrence. * Any other serious underlying medical, psychiatric, psychological, familial, or geographical * condition, which in the judgment of the investigator may interfere with the planned * staging, treatment and follow-up, which affect patient compliance or place the patient at * high risk from treatment-related complications. * Vulnerable men (participants incapable of judgment or participants under tutelage) will not be included in the study.

Locations (15)

Cantonal Hospital Aarau

Aarau, Switzerland

RECRUITING

University Hospital Basel

Basel, Switzerland

Outcomes

Primary Outcomes

Prostate specific antigen (PSA) persistence

defined as failure to reach a PSA value of \<0.1 ng/ml

Time frame: 3 month (+/- 2 weeks) postoperatively

Biochemical recurrence free survival (BCRFS)

time from randomization to biochemical recurrence, defined as serum PSA level ≥ 0.2 ng/ml

Time frame: within 24 months post surgery

Secondary Outcomes

PSA persistence (PSAP) above detection limit

cut-off ≥ 0.03 ng/ml

Time frame: postoperative to the end of the study at 10-15 years

Initiation time of adjuvant or salvage therapies

Calculated from randomization to the start of any adjuvant or salvage therapy. Salvage radiotherapy (SRT) to the prostatic fossa only excluding lymphatics and without androgen deprivation therapy) will not count as an event for this endpoint if: * A PSMA-PET-computed tomography prior to SRT was negative for disease beyond the prostatic fossa, and * the SRT led to a PSA \<0.1 ng/ml (PSAP) or ≤ 0.2 ng/ml (biochemical recurrence-free survival, BCRFS), respectively.

Time frame: postoperative to the end of the study at 10-15 years

Time to loco-regional recurrence

Calculated from randomization until the first local (prostate bed) or regional (within the extent of the ePLND template) recurrence.

Time frame: from randomization to end of study at 10-15 years

Localization of progression

Prostate-specific membrane antigen positron emission tomography (PSMA-PET)

Time frame: from randomization to end of study at 10-15 years

Central Contacts

Cyrill Rentsch, Prof. Dr. med.

CONTACT

+41 61 26 87122 cyrill.rentsch@usb.ch

Data from ClinicalTrials.gov

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