title: Salvage lymph node dissection for nodal recurrence of prostate cancer after radical prostatectomy.
abstract: OBJECTIVE
  We analyzed the impact of salvage lymph node dissection on the prognosis in patients with biochemical recurrence and positive lymph nodes on positron emission tomography/computerized tomography after radical prostatectomy.
  
  
  METHODS
  We retrospectively analyzed the records of 58 patients who underwent pelvic and/or retroperitoneal salvage lymph node dissection from June 2005 to February 2012. Biochemical response was defined as prostate specific antigen less than 0.2 ng/ml 40 days after salvage treatment. Biochemical recurrence in those with a biochemical response was defined as prostate specific antigen greater than 0.2 ng/ml and increasing. Kaplan-Meier curves were used to assess time to biochemical recurrence, clinical recurrence and cancer specific survival. Cox and binary logistic regressions were used to determine factors influencing clinical recurrence and biochemical response.
  
  
  RESULTS
  Median followup after salvage lymph node dissection was 39 months. A total of 13 patients (22.4%) achieved a biochemical response. Only 1 patient remained free of biochemical recurrence during followup. Clinical recurrence developed in 25 patients (48.1%) after salvage treatment. Six patients (10.3%) died of disease, including 4 with indeterminate extralymphatic findings on positron emission tomography/computerized tomography before salvage therapy. The 5-year cancer specific survival rate was 71.1%. Patients with a complete biochemical response showed a trend toward a longer time to clinical recurrence (p = 0.20). Biochemical response did not influence cancer specific survival.
  
  
  CONCLUSIONS
  Salvage lymph node dissection in patients with biochemical recurrence and positive lymph nodes on positron emission tomography/computerized tomography led to a biochemical response in a certain proportion. Most patients progressed to biochemical recurrence after salvage treatment but almost half showed no further clinical recurrence. Cancer specific mortality occurred predominantly in patients with prior suspicion of extralymphatic lesions. Salvage lymph node dissection may delay androgen deprivation therapy and clinical recurrence in select patients.
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany; Martini-Clinic Prostate Cancer Center and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. Electronic address: d.tilki@uke.de.
authors.forename: Derya
authors.initials: D
authors.lastname: Tilki
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Mandel
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany.
authors.forename: Flora
authors.initials: F
authors.lastname: Seeliger
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kretschmer
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Karl
authors.affiliation: Institute of Anatomy and Cell Biology, University of Würzburg, Würzburg, Germany.
authors.forename: Süleyman
authors.initials: S
authors.lastname: Ergün
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany; UroClinic Bogenhausen, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Seitz
authors.affiliation: Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
mesh_terms: D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D008297:Male; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D049268:Positron-Emission Tomography; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy; D014057:Tomography, X-Ray Computed
keywords: lymph node excision; prostate-specific antigen; prostatectomy; prostatic neoplasms; salvage therapy