title: Salvage Pelvic Lymph Node Dissection after Radical Prostatectomy for Biochemical and Lymph Node Recurrence.
abstract: Prostate cancer is the most common male malignancy. Radiation therapy and radical prostatectomy are the main curative treatment options for organ confined disease. Despite the good long-term oncologic outcomes, roughly 40% of patients undergoing surgery develop biochemical recurrence, manifested as a rising prostate-specific antigen (PSA). Those patients are at higher risk of developing a local or distant recurrence. The diagnosis of a nodal recurrence is challenging. This report is about a 66-year-old male, who had a radical prostatectomy in 2006. Postoperatively, the PSA was never undetectable. Radiotherapy was delivered in 2007, but the PSA rose again. Anti-androgen therapy was started, but he developed painful mastodynia. A (11C) choline PET-CT showed an enlarged suspicious lymph node at the left common iliac and a salvage pelvic lymphadenectomy was performed. Postoperatively, the PSA remained undetectable for the last 5 years. The use of lesion - targeted therapy for oligometastatic disease is a new concept in urology, aiming at reducing the tumor burden. Therefore, even though this surgical approach might not be associated with a durable response over time, the tumor load is decreased and further cancer progression might be delayed, allowing to postpone the delivery of hormone therapy.
authors.affiliation: Department of Urology, UZ Gasthuisberg, Leuven, Belgium.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Peeters
authors.forename: Diederik
authors.initials: D
authors.lastname: Ponette
authors.forename: Hendrik
authors.initials: H
authors.lastname: van Poppel
mesh_terms: D000368:Aged; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D000072078:Positron Emission Tomography Computed Tomography; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000601:surgery*; D016879:Salvage Therapy; D013520:Urologic Surgical Procedures
chemical_list: D017430:Prostate-Specific Antigen