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Prostate Cancer

Long-term Outcomes of Salvage Lymph Node Dissection for Clinically Recurrent Prostate Cancer: Results of a Single-institution Series with a Minimum Follow-up of 5 Years

By: Nazareno Suardi a , Giorgio Gandaglia a , Andrea Gallina a , Ettore Di Trapani a , Vincenzo Scattoni a , Damiano Vizziello a , Vito Cucchiara a , Roberto Bertini a , Renzo Colombo a , Maria Picchio b , Giampiero Giovacchini b , Francesco Montorsi a and Alberto Briganti a lowast

European Urology, Volume 67 Issue 2, February 2015, Pages 299-309

Published online: 01 February 2015

Keywords: Salvage lymph node dissection, Prostate cancer, Clinical recurrence, Cancer-specific mortality, Lymph node metastases

Abstract Full Text Full Text PDF (1,8 MB) Patient Summary

Abstract

Background

Prostate cancer (PCa) patients with lymph node recurrence after radical prostatectomy (RP) are usually managed with androgen-deprivation therapy. Despite the absence of prospective randomized studies, salvage lymph node dissection (LND) has been proposed as an alternative treatment option.

Objective

To examine long-term outcomes of salvage LND in patients with nodal recurrent PCa documented by 11C-choline positron emission tomography/computed tomography (PET/CT) scan.

Design, setting, and participants

Overall, 59 patients affected by biochemical recurrence (BCR) with 11C-choline PET/CT scan with pathologic activity treated between 2002 and 2008 were included.

Intervention

Pelvic and/or retroperitoneal salvage LND.

Outcome measurements and statistical analyses

Biochemical response (BR) was defined as prostate-specific antigen (PSA) <0.2 ng/ml at 40 d after surgery. BCR for those who achieved BR was defined as a PSA >0.2 ng/ml. Clinical recurrence (CR) was defined as a positive PET/CT scan after salvage LND in the presence of a rising PSA. Kaplan-Meier curves assessed time to BCR, CR, and cancer-specific mortality (CSM). Cox regression analyses were fitted to assess predictors of CR.

Results and limitations

Median follow-up after salvage LND was 81.1 mo. Overall, 35 patients (59.3%) achieved BR. The 8-yr BCR-free survival rate in patients with complete BR was 23%. Overall, the 8-yr CR- and CSM-free survival rates were 38% and 81%, respectively. In multivariable analyses evaluating preoperative variables, PSA at salvage LND represented the only predictor of CR (p = 0.03). When postoperative variables were considered, BR and the presence of retroperitoneal lymph node metastases were significantly associated with the risk of CR (allp≤ 0.04). Our study is limited by the lack of a control group.

Conclusions

Salvage LND may represent a therapeutic option for patients with BCR after RP and nodal pathologic uptake at 11C-choline PET/CT scan. Although most patients progressed to BCR after salvage LND, roughly 40% of them experienced CR-free survival.

Patient summary

Salvage lymph node dissection may represent a therapeutic option for selected patients with nodal recurrence after radical prostatectomy. Roughly 40% of men did not show any further clinical recurrence at long-term follow-up after surgery.

Take Home Message

Salvage lymph node dissection might represent a treatment approach for selected patients with imaging-detected nodal recurrence after radical prostatectomy. Despite almost invariable biochemical progression, approximately 40% of patients did not show any further clinical recurrence at 8 yr after surgery. The best candidates for this approach seem to be those men with a low volume of recurrent nodal disease limited to the lymphatic pelvic areas.

Keywords: Salvage lymph node dissection, Prostate cancer, Clinical recurrence, Cancer-specific mortality, Lymph node metastases.

Footnotes

a Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy

b Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy

lowast Corresponding author. Department of Urology, URI-Urological Research Institute, San Raffaele Hospital, University Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy. Tel. +39 02 26436923; Fax: +39 02 26437298.

Both authors contributed equally to the manuscript.

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