Salvage lymph node dissection in patients with oligometastatic recurrence of prostate cancer confirmed by PET-CT

Abstract

Background . Due to the development of visualization methods of examination in a heterogenous group of patients with prostate cancer recurrence, it has become possible to detect cases of oligometastatic disease. The objective is to evaluate intermediate term surgical and oncological results of salvage lymph node dissection (sLND) in patients with oligometastatic recurrence of prostate cancer confirmed by positron emission tomography-computed tomography (PET-CT). Materials and methods . The experience of treatment of 13 patients with recurrent prostate cancer who underwent sLND is presented. The characteristics of patients prior to sLND, surgical and oncological results were evaluated. A comparison of sLND results after PET-CT with choline and 68 Ga-prostate specific membrane antigen ( 68 Ga-PSMA) was performed. Results . Median age was 65years (interquartile range (IQR) 59—70 years), median level of prostate-specific antigen was 2.8 ng/ml (IQR 1.3—4.6 ng/ml). Complications were observed in 4 of 13 patients (grade III а or lower per the Clavien—Dindo classification). Median follow-up duration was 46 months (IQR 11—50 months), response to sLND was observed in 6 patients and full response (prostate-specific antigen level <0.2 ng/ml) in 4. Median time to prescription of androgen deprivation therapy after sLND was 13.6 months (IQR 5.2—30.7 months). In 5 patients, for maximum follow-up period androgen deprivation therapy wasn’t performed. No statistically significant differences between patients who underwent sLND after PET-CT with choline and 68 Ga-PSMA, were observed except for the follow-up period. Conclusion . Therefore, sLND in carefully selected patients is a safe intervention allowing to delay or fully cancel androgen deprivation therapy in the presented follow-up period.