PURPOSE: To report salvage lymph node dissections (sLND) for prostate cancer nodal recurrence detected by 11C-choline positron emission tomography/computed tomography (PET/CT)in the setting of rising PSA after radical prostatectomy (RP).
MATERIALS AND METHODS: Retrospective chart review was performed for all patients who underwent sLND for prostate cancer nodal recurrence. Only patients previously treated with RP were included. Patients with evidence of local recurrence were excluded. Primary endpoints included biochemical recurrence, systemic progression, and cancer-specific mortality.
RESULTS: From 2009-2013, 52 men underwent a sLND. Prior to sLND, 78.8% (41/52) had some form of post-RP therapy. Median age at sLND was 60 years while median PSA was 2.2 ng/mL (IQR 1.4-3.7). The median number of lymph nodes dissected was 21.5 (IQR 16-30) and median number of positive nodes was 3.5 (IQR 1.2-6.5). Since sLND, 46.2% (24/52) have had no further treatment, 34.6% (18/52) are on hormonal therapy, and 19.2% (10/52) have received multiple different treatments. At the last follow-up, median of 20 months (IQR 8,33), PSA remained < 0.2 ng/ml in 57.7% (30/52), 75% (39/52) remained free of systemic progression, and 96.2% (50/52) were alive. Two patients died from prostate cancer. Three-year BCR-free, systemic progression-free and cancer-specific survivals were 45.5%, 46.9% and 92.5%, respectively.
CONCLUSION: This represents the largest U.S. series of sLND in the setting of lymph node metastatic prostate cancer post RP. Although follow-up is short and the study lacks a randomized control group, sLND may represent a valid treatment option.
Karnes RJ, Murphy CR, Bergstralh EJ, DiMonte G, Cheville JC, Lowe VJ, Mynderse LA, Kwon ED. Are you the author?
Department of Urology, Mayo Clinic, 200 First Street SW Rochester, MN, 55905; Department of Health Sciences Research, Mayo Clinic, 200 First Street SW Rochester, MN, 55905; Department of Pathology, Mayo Clinic, 200 First Street SW Rochester, MN, 55905; Department of Radiology, Mayo Clinic, 200 First Street SW Rochester, MN, 55905.
Reference: J Urol. 2014 Aug 20. pii: S0022-5347(14)04255-4.