Evaluation of safety and advisability of salvage lymph node dissection in patients with lymphogenic metastases of prostate cancer after radical treatment

Abstract

Background. The rate of prostate cancer progression after radical treatment is about 40 %. Currently, some data suggest that patients with oligometastases have a more favorable prognosis than patients with extensive tumor lesions. In 78 % of cases, oligometastases are localized in the pelvic and retroperitoneal lymph nodes. Surgical removal of all detectable metastases can cure prostate cancer recurrence, however the possibility of using salvage lymph node dissection (sLND) in clinical practice remains limited due to the lack of data on surgical and oncological outcomes of this treatment method. The study objective is to evaluate surgical and early oncological outcomes of sLND in patients with progressive prostate cancer after radical treatment. Materials and methods . The study was conducted at the N.N. Blokhin National Medical Research Center of Oncology. The analysis included 17 patients with biochemical prostate cancer recurrence and symptoms of lymphogenic disease progression based on positron emission tomography/computed tomography with radiopharmaceuticals 18 F-choline (n = 14; 82.35 %) and 68 Ga-prostate-specific membrane antigen (n = 1; 5.88 %) and magnetic resonance lymphography with Combidex (ultra-small superparamagnetic iron oxides, USPIO) (n = 2; 12.0 %). All patients underwent sLND in the period from October of 2014 to December of 2016. Results. Postoperative complications were observed in 58.8 % (n = 10) of cases. No grade III and IV complications per the Clavien–Dindo classification were registered. For median follow up duration of 17.5 (5–31) months, full biochemical response in the form of decreased prostate-specific antigen < 0.2 ng/ml was observed in 5 (29.4 %) patients. Mean time to prescription of hormone therapy was 6.6 (1–12) months. Considering this follow up duration, 53 % of patients hadn’t received hormone therapy. Conclusion. Therefore, sLND is a safe surgical intervention with low number of severe complications. sLND can be successfully used in wellselected patients as a diagnostic tool and provide accurate information on the state of lymph nodes. Removal of oligometastases allows to achieve long-term relapse-free period in individual patients and postpone prescription of hormone therapy.