The role of salvage extended lymph node dissection in patients with rising PSA and PET/CT scan detected nodal recurrence of prostate cancer.
Non-prostatic bed recurrence of prostate cancer (PCa) is usually treated with androgen deprivation therapy (ADT). We analyzed the impact of salvage extended lymph node dissection (sLND) on cancer control in patients with rising PSA and lymph node (LN) metastases.



Between 2009 and 2016 we performed sLND in 87 patients with biochemical recurrence (BCR) and positive LNs on18FEC and68Ga-PSMA positron emission tomography/X-ray computer tomography (PET/CT) after primary treatment (PT) of PCa. Intra- and postoperative complications according to Clavien-Dindo were assessed and the rates of biochemical response (BR), BCR-free and clinical recurrence (CR)-free survival, as well as time to initiation of systemic treatment were evaluated.



Mean age of patients and mean PSA at sLND was 66.7 years (46-80 years) and 2.63 ng ml-1(1.27-3.75 ng ml-1), respectively. With 87.4% radical prostatectomy (RP) was the most common PT. In all, 57.9% of patients additionally underwent adjuvant/salvage radiation therapy (RT) and 18.4% received ADT before sLND. Complete BR (cBR) was diagnosed in 27.5% of patients and incomplete BR in 40.6%. In total, 62.2% of patients remained without ADT at follow-up. With a median follow-up of 21 months (1-75 months), the cancer-specific mortality rate was 3.7%. The 3-year BCR-free, systemic therapy-free and CR-free survival rates for patients with cBR were 69.3%, 77.0% and 75%, respectively.



sLND can be performed without significant complications and achieves an immediate BR, thus allowing a significant postponement of systemic therapy in selected patients with BCR and nodal recurrence of PCa. Therefore, sLND following68Ga-PSMA PET/CT should be considered as part of a multimodal diagnostic and treatment concept for selective patients.
Department of Urology, University Hospital of Cologne, Cologne, Germany.
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D
Porres
Department of Urology, University Hospital of Cologne, Cologne, Germany.
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D
Pfister
Department of Urology, University Hospital of Cologne, Cologne, Germany.
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A
Thissen
Department of Urology, University Hospital of Cologne, Cologne, Germany.
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TH
Kuru
Department of Urology, University Hospital of Cologne, Cologne, Germany.
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V
Zugor
Department of Pathology, University Hospital of Cologne, Cologne, Germany.
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R
Buettner
Department of Pathology, RWTH University Hospital Aachen, Aachen, Germany.
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R
Knuechel
Department of Nuclear Medicine, RWTH University Hospital Aachen, Aachen, Germany.|Department of Nuclear Medicine, University Hospital Gießen and Marburg, Marburg, Germany.
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Verburg
Department of Urology, University Hospital of Cologne, Cologne, Germany.
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Heidenreich
D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods; D017430:Prostate-Specific Antigen; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D016879:Salvage Therapy; D016896:Treatment Outcome
D017430:Prostate-Specific Antigen