Abstract
Introduction and ObjectivesWe report our experience with salvage lymph node dissection (sLND) in oligorecurrent prostate cancer (PCa) post radical prostatectomy (RP).Material and MethodsWe retrospectively analyzed data of 24 patients who underwent sLND for biochemical recurrence (BCR) post RP, from July 2012 to February 2018. sLND was performed following an extended bilateral template. Clinical and pathological characteristics of primary RP and sLND were reported. Biochemical response and initiation of additional therapy post sLND were analyzed. Survival analysis was performed using KaplanMeier curves.Results24 sLND were performed. RP specimens showed 58.3% of Gleason score 7 and 50% of locally advanced disease. Median time to BCR post RP was 24 months with a median PSA value of 1.4 ng/ml pre sLND. 75% of patients underwent imaging prior to sLND. sLND showed oligometastasis on the final pathology report in 54.2% of patients. Metastatic lymph nodes were mainly identified in the iliac artery territory (61.5%). Complete biochemical response (PSA < 0.2 ng/ml) was maintained throughout the first 12 months of follow-up in 20.83% of patients and 8.33% of patients at the end of the study (median follow-up 70 months). Survival rates free of additional therapy (ADT/RT) were 45.83% at one year and 25% at 5 years.ConclusionsWe observed a biochemical response post sLND in 20.83% of our patients, lasting throughout the first year of follow up, with survival rates free of ADT and/or RT of 45.83% at one year and 25% at 5 years.
Highlights
Introduction and ObjectivesWe report our experience with salvage lymph node dissection in oligorecurrent prostate cancer (PCa) post radical prostatectomy (RP)
Exclusion criteria were patients previously treated with salvage or adjuvant radiotherapy to the whole pelvis, evidence of distant metastasis, patients under androgen deprivation therapy (ADT) and the presence of a positive margin in the RP specimen
The oncological outcomes that we examined were biochemical response following salvage lymph node dissection (sLND), timing and need for additional therapy (RT/ADT) and survival free of additional therapy
Summary
We report our experience with salvage lymph node dissection (sLND) in oligorecurrent prostate cancer (PCa) post radical prostatectomy (RP). In 2021, more than 35 000 new cases of prostate cancer (PCa) will be diagnosed in Spain, and approximately 5 800 patients will die from this disease [1, 2]. Treatment in the context of oligoprogression to lymph nodes following radical prostatectomy (RP) was limited to salvage radiation therapy (RT) and/or androgen deprivation therapy (ADT). SLND has not demonstrated survival benefit or potential for cure in patients with biochemical recurrence (BCR) post RP but has led to complete biochemical responses (PSA < 0.2 ng/ml) in some patients, in addition to delaying ADT initiation [8,9,10]. We report results from our cohort of 24 patients with BCR after RP, in which we performed sLND
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