The impact of adding sentinel node biopsy to extended pelvic lymph node dissection on the biochemical recurrence of prostate cancer patients treated with robot-assisted radical prostatectomy

The benefit of adding sentinel node biopsy (SNB) to extended pelvic lymph node dissection (ePLND), remains controversial. Aim of our study was to evaluate biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP) and ePLND in prostate cancer (PCa) patients, stratified by the application of SNB. The results were compared with the predictions of the updated Memorial Sloan Kettering Cancer Center (MSKCC) nomogram. Methods: Between January 2006 and November 2016, 920 patients underwent RARP with ePLND combined with or without SNB (184 and 736 patients, respectively). BCR was defined as two consecutive prostate-specific antigen (PSA) rises ≥ 0.2 ng/ml. The Kaplan-Meier method and Cox regression analyses were used to identify predictors of BCR. Results: Median follow up was 28 months (interquartile range: 13-56.7). The 5-year BCR-free survival rate was 80.5% and 69.9% in the ePLND+SNB and ePLND group, respectively. At multivariate analysis PSA, primary gleason grade > 3, seminal vesicle invasion and higher number of removed and positive nodes were independent predictors of BCR in the ePLND group. In the ePLND+SNB group only the number of positive nodes was independent predictor of BCR. The overall accuracy of MSKCC nomogram was higher in the ePLND+SNB compared to the ePLND group. However, the nomogram was underestimating the probability of BCR-free status in the ePLND+SNB group, while the ePLND group was performing as predicted. Conclusion: Adding SNB to ePLND improves BCR-free survival, although it remains speculation on the precise explanation of this observation. Our results should be interpreted cautiously, given the non-randomized nature and the selection bias of the study.

Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2017 Jul 26 [Epub ahead of print]

Nikolaos Grivas, Esther Wit, Teele Kuusk, Gijs KleinJan, Maarten Donswijk, Fijs van Leeuwen, Henk van der Poel

The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Netherlands., Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam,, Netherlands., Department of Urology, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands, Netherlands., Department of Nuclear Medicine, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Am, Netherlands., Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Cent, Netherlands.

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