Salvage lymph node dissection for nodal recurrence of prostate cancer after radical prostatectomy - Abstract

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.

Written by:
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.
doi: 10.1016/j.juro.2014.08.096

PubMed Abstract
PMID: 25180792 Prostate Cancer Section