PURPOSE: We analyzed the impact of salvage lymph node dissection (sLND) on prognosis of patients with biochemical recurrence (BCR) and positive LN in positron emission tomography/computed tomography (PET/CT) scan after radical prostatectomy (RP).
MATERIALS AND METHODS: A total of 58 patients who underwent pelvic and/or retroperitoneal sLND from June 2005 to February 2012 were retrospectively analyzed. Biochemical response (BR) was defined as prostate-specific antigen (PSA) < 0.2 ng/ml at 40 d after sLND, BCR for those who achieved BR was defined as PSA >0.2 ng/ml and rising. Kaplan-Meier curves assessed time to BCR, clinical recurrence (CR) and cancer specific survival (CSS). Cox regressions and binary logistic regressions addressed factors influencing CR and BR.
RESULTS: Median follow-up after sLND was 39 months. Overall, 13 patients (22.4%) achieved BR. Only one patient remained free of BCR during follow-up. Clinical recurrence occurred in 25 patients (48.1%) after sLND. Six patients (10.3%) died of their disease, whereby 4 of these had indeterminate extralymphatic findings on PET/CT prior to sLND. 5-year CSS was 71.1%. Patients with complete BR had a trend towards a longer time to CR (p=0.20). BR did not influence CSS.
CONCLUSIONS: Although salvage lymph node dissection in patients with BCR and positive LN in PET/CT leads to BR in a certain proportion of patients, most patients progressed to BCR after sLND. Nevertheless, almost half of the patients did not show further CR. Cancer-specific mortality (CSM) predominantly occurred in patients with prior suspicion of extralymphatic lesions. SLND may delay ADT and CR in selected patients.
Tilki D, Mandel P, Seeliger F, Kretschmer A, Karl A, Ergün S, Seitz M, Stief CG. Are you the author?
Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany; Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Institute of Anatomy and Cell Biology, University of Würzburg, Würzburg, Germany; UroClinic Bogenhausen, Munich, Germany.
Reference: J Urol. 2014 Aug 30. pii: S0022-5347(14)04351-1.