Abstract
ABSTRACTProstate cancer is the most common invasive cancer in men. Radical prostatectomy (RP) is a definitive treatment option, but biochemical recurrence can reach 40%. Salvage lymphadenectomy is a relatively recent approach to oligometasis and has been rapidly diffused primarily due to improvement in imaging diagnosis and results showing possibly promising therapy. A systematic literature review was performed in March 2020, according to the PRISMA statement. We excluded studies with patients with suspicion or confirmation of visceral and / or bone metastases. A total of 27 articles were included in the study. All studies evaluated were single arm, and there were no randomized studies in the literature. A total of 1,714 patients received salvage lymphadenectomy after previous treatment for localized prostate cancer. RP was the most used initial therapeutic approach, and relapses were based on PET / CT diagnosis, with Coline-11C being the most widely used radiopharmaceutical. Biochemical response rates ranged from 0% to 80%. The 5 years - Free Survival Biochemical recurrence was analyzed in 16 studies with rates of 0% up to 56.1%. The articles do not present high levels of evidence to draw strong conclusions. However, even if significant rates of biochemical recurrence are not evident in all studies, therapy directed to lymph node metastases may present good oncological results and postpone the onset of systemic therapy. The long-term impact in overall survival and quality of life, as well as the best strategies for case selection remains to be determined.
Highlights
Prostate cancer (PCa) is the most common invasive cancer in men [1]
Refinements in imaging methods, such as magnetic resonance imaging (MRI), computed tomography (CT), 11C-choline positron emission tomography (PET)/CT [11,12,13,14,15,16] and more recently, 68-Gadolinium-prostate-specific membrane antigen (PSMA) [17,18,19,20,21], have allowed clinicians to distinguish between patients with lymph node recurrence and others with bone or visceral metastasis [22]
We aimed to include in this systematic review studies reporting on patients with PCa treated with curative intent and recurrence pattern of exclusive lymph node metastasis
Summary
Prostate cancer (PCa) is the most common invasive cancer in men [1]. Despite more accurate case selection using modern imaging techniques and advances in treatment (either surgery or radiation therapy) [2], recurrence after primary curative treatment remains significant. Patients with biochemical recurrence are usually referred to radiation therapy if residual disease in prostatic fossa is suspected [8] or to androgen deprivation therapy (ADT) if lymph node or systemic metastasis are detected [9, 10]. Refinements in imaging methods, such as magnetic resonance imaging (MRI), computed tomography (CT), 11C-choline positron emission tomography (PET)/CT [11,12,13,14,15,16] and more recently, 68-Gadolinium-prostate-specific membrane antigen (PSMA) [17,18,19,20,21], have allowed clinicians to distinguish between patients with lymph node recurrence and others with bone or visceral metastasis [22]
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