Abstract
Biochemical recurrence (BCR) occurs up to 40% of men who had radical prostatectomy for localized prostate cancer. Regional nodes are usually involved in these cases. Salvage lymphadenectomy (sLND) has been advocated in patients with 'node-only' metastasis with biochemical recurrence, following a definitive treatment of primary prostate cancer. In general, limited case number was reported for each previous study. Four relatively larger reports so far with the highest case number of 189. One randomized controlled study has been completed so far at Phase II level. Salvage LND seems to be safe with relatively low incidence of complications without perioperative mortality. It may postpone adjuvant therapy in selected cases, avoiding systemic side effects and possibly reducing the cost. However, long-term outcome is not very encouraging.
Highlights
Biochemical recurrence (BCR) occurs up to 40% of men who had radical prostatectomy for localized prostate cancer
Salvage Lymph Node Dissection cBCR (LND) seems to be safe with relatively low incidence of complications without perioperative mortality
Pooled detection rate (DR) increased to 65% when prostate-specific antigen (PSA) doubling time (PSAdt) was ≤6 months and to 71% and 77% when PSA level was >1 or >2 ng/ mL per year, respectively
Summary
Biochemical recurrence (BCR) occurs in up to 40% of men who had radical prostatectomy (RP) for localized prostate cancer (PCa) [1, 2]. They found that modern imaging techniques underestimate the tumor burden and the surgical sLND template should not be limited to the positive spots on pre-operative imaging [31] In another retrospective study with 31 patients to describe the technique, feasibility, and short-term outcomes of 99mTechnetium (99mTc)-based PSMAradioguided surgery (99mTc-PSMA-RGS) for removal of recurrent PCa lesions, salvage surgery with intraoperative radioguidance using a gamma probe was performed after intravenous application of 99mTcPSMA investigation and surgery (mean activity 571 MBq, mean time to surgery 19.7h). In the other study with a median follow-up of 72 months, 10 of 11 patients with histologically confirmed lymph node metastases showed a PSA response after sLND. The median time from sLND to biochemical recurrence was 2 months They found that PSMA PET/CT scans in hormone-naïve patients are currently too imprecise to diagnose metastatic sites [37]. They thought these men should instead be considered at high risk of systemic dissemination already at the time of sLND [35]
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