title: Salvage lymph node dissection for prostate cancer nodal recurrence detected by 11C-choline positron emission tomography/computerized tomography.
abstract: OBJECTIVE
  We report salvage lymph node dissections for prostate cancer nodal recurrence detected by (11)C-choline positron emission tomography/computerized tomography in the setting of increasing prostate specific antigen after radical prostatectomy.
  
  
  METHODS
  Retrospective chart review was performed for all patients who underwent salvage lymph node dissection for prostate cancer nodal recurrence. Only patients previously treated with radical prostatectomy were included in the study and those with evidence of local recurrence were excluded from analysis. Primary end points included biochemical recurrence, systemic progression and cancer specific mortality.
  
  
  RESULTS
  From 2009 to 2013, 52 men underwent salvage lymph node dissection. Before salvage lymph node dissection 78.8% (41 of 52) had some form of therapy after radical prostatectomy. Median age at salvage lymph node dissection was 60 years and median prostate specific antigen was 2.2 ng/ml (IQR 1.4-3.7). The median number of lymph nodes dissected was 21.5 (IQR 16-30) and the median number of positive nodes was 3.5 (IQR 1.2-6.5). Since salvage lymph node dissection 46.2% of the men (24 of 52) have had no further treatment, 34.6% (18 of 52) are on hormonal therapy and 19.2% (10 of 52) have received multiple different treatments. At the last followup at a median of 20 months (IQR 8-33), 57.7% (30 of 52) had prostate specific antigen remain less than 0.2 ng/ml, 75% (39 of 52) remained free of systemic progression and 96.2% of the men (50 of 52) were alive. Two patients died of prostate cancer. Three-year biochemical recurrence-free, systemic progression-free and cancer specific survival was 45.5%, 46.9% and 92.5%, respectively.
  
  
  CONCLUSIONS
  This represents the largest U.S. series of salvage lymph node dissection in the setting of lymph node metastatic prostate cancer after radical prostatectomy. Although followup was short and the study lacked a randomized control group, salvage lymph node dissection may represent a valid treatment option.
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota. Electronic address: Karnes.r@mayo.edu.
authors.forename: R Jeffrey
authors.initials: RJ
authors.lastname: Karnes
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Murphy
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Bergstralh
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Guy
authors.initials: G
authors.lastname: DiMonte
authors.affiliation: Department of Pathology, Mayo Clinic, Rochester, Minnesota.
authors.forename: John C
authors.initials: JC
authors.lastname: Cheville
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Val J
authors.initials: VJ
authors.lastname: Lowe
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Lance A
authors.initials: LA
authors.lastname: Mynderse
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Eugene D
authors.initials: ED
authors.lastname: Kwon
mesh_terms: D000368:Aged; D002250:Carbon Radioisotopes; D002794:Choline; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D049268:Positron-Emission Tomography; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy; D014057:Tomography, X-Ray Computed
chemical_list: D002250:Carbon Radioisotopes; D002794:Choline
keywords: choline; lymph node excision; lymphatic metastasis; prostatic neoplasms; recurrence