title: Pelvic/retroperitoneal salvage lymph node dissection for patients treated with radical prostatectomy with biochemical recurrence and nodal recurrence detected by [11C]choline positron emission tomography/computed tomography.
abstract: BACKGROUND
  The management of patients with clinical recurrence of prostate cancer after radical prostatectomy (RP) remains challenging.
  
  
  OBJECTIVE
  To determine whether the removal of positive lymph nodes at [11C]choline positron emission tomography/computed tomography (PET/CT) scan may have an impact on the prognosis of patients with biochemical recurrence (BCR) and nodal recurrence after RP.
  
  
  METHODS
  Prospective analysis of 72 patients affected by BCR after RP associated with a nodal pathologic [11C]choline PET/CT scan.
  
  
  METHODS
  Patients underwent salvage lymph node dissection (LND).
  
  
  METHODS
  Biochemical response (BR) to treatment was defined as prostate-specific antigen (PSA) <0.2 ng/ml at 40 d after salvage LND. Kaplan-Meier and Cox regression analyses addressed time to and predictors of clinical recurrence (CR) after salvage LND, respectively.
  
  
  CONCLUSIONS
  Overall, 56.9% of patients achieved BR. Mean and median follow-up after LND were 39.4 and 39.8 mo, respectively. The 5-yr BCR-free survival rate was 19%. Preoperative PSA <4 ng/ml (hazard ratio [HR]: 0.12; p = 0.005), time to BCR <24 mo (HR: 7.52; p = 0.005), and negative lymph nodes at previous RP (HR: 0.19; p=0.04) represented independent predictors of BR. Overall, 5-yr CR-free and cancer-specific survival were 34% and 75%, respectively. At multivariable analyses, only PSA >4 ng/ml (HR: 2.13; p=0.03) and the presence of retroperitoneal uptake at PET/CT scan (HR=2.92; p=0.004) represented independent preoperative predictors of CR. Similarly, the presence of pathologic nodes in the retroperitoneum (HR: 2.78; p=0.02), higher number of positive lymph nodes (HR: 1.04; p=0.006), and complete BR to salvage LND (HR: 0.31; p=0.002) represented postoperative independent predictors of CR. Main limitations consisted of the lack of a control group and the heterogeneity of patients included in the analyses.
  
  
  CONCLUSIONS
  Salvage LND is feasible in patients with BCR after RP and nodal pathologic uptake at [11C]choline PET/CT scan. Biochemical response after surgery can be achieved in a consistent proportion of patients. Although most patients invariably progressed to BCR after surgery at longer follow-up, 35% of patients showed the absence of CR at 5 yr.
authors.affiliation: Department of Urology, Urological Research Institute, University Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Luigi F
authors.initials: LF
authors.lastname: Da Pozzo
authors.forename: Manuela
authors.initials: M
authors.lastname: Tutolo
authors.forename: Luca
authors.initials: L
authors.lastname: Villa
authors.forename: Andrea
authors.initials: A
authors.lastname: Gallina
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Scattoni
authors.forename: Renzo
authors.initials: R
authors.lastname: Colombo
authors.forename: Massimo
authors.initials: M
authors.lastname: Freschi
authors.forename: Maria
authors.initials: M
authors.lastname: Picchio
authors.forename: Cristina
authors.initials: C
authors.lastname: Messa
authors.forename: Giorgio
authors.initials: G
authors.lastname: Guazzoni
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
mesh_terms: D000368:Aged; D002794:Choline / Q000031:analogs & derivatives*; D018572:Disease-Free Survival; D005240:Feasibility Studies; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000009:adverse effects / Q000401:mortality; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D010388:Pelvis; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000009:adverse effects / Q000401:mortality; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D019275:Radiopharmaceuticals; D012187:Retroperitoneal Space; D018570:Risk Assessment; D012307:Risk Factors; D016879:Salvage Therapy / Q000009:adverse effects / Q000401:mortality; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure
chemical_list: D019275:Radiopharmaceuticals; C447081:methyl carbon-11 choline; D017430:Prostate-Specific Antigen; D002794:Choline