Comment on: "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".

Abstract

The relatively poor outcome with regard to freedom from biochemical recurrence leads to a demand for preoperative clinical predictors that may select patients responding to LND. In the present study, multivariate analysis identified “number of positive lymph nodes” and “postoperative PSA response” as predictors for freedom from biochemical recurrence. These parameters, however, are only available after LND has been performed. The only preoperative parameter showing a statistical association with biochemical recurrence in this study was the initial PSA value. All patients without initial biochemical response after LND were put on androgen deprivation therapy (ADT) for a minimum of 2 years. Therefore, the results presented here have to be interpreted with care. In total, 66.1 % patients were under continued ADT at the end of follow-up. This is an important fact that may be missed while screening the abstract of the above-mentioned paper. It must be stated clearly that the results cannot exclusively be attributed to LND. The current study does not provide us with a direct randomized comparison of ADT versus salvage LND. Prospective trials trying to assess this question are pending [4]. Considering the relatively low rate of patients that remained free from biochemical recurrence, LND should not be discussed as a curatively intended therapy but rather as a potential way of delaying ADT and its known side effects. The present study shows that LND is associated with surgery-associated morbidity: In total, 11 of the 59 patients (18.6 %) experienced postoperative morbidity with a Clavien score of ≥3a. The rate of any adverse event was even as high as 91.5 %. Patients with recurrent prostate cancer tend to have low sensitivity and low detection rates on imaging studies when PSA is low. At the same time, low PSA values are beneficial with regard to freedom from clinical recurrence under Dear Editor