Abstract
Methodology. Seventeen patients with prostate-specific antigen (PSA) rise following local treatment for prostate cancer with curative intent underwent open or minimally invasive salvage pelvic lymph node dissection (SLND) for oligometastatic disease (<4 synchronous metastases) or as staging prior to salvage radiotherapy. Biochemical recurrence after complete biochemical response (cBR) was defined as 2 consecutive PSA increases >0,2 ng/mL; and after incomplete biochemical response as 2 consecutive PSA rises. Newly found metastasis on imaging defined clinical progression (CP). Palliative androgen deprivation therapy (ADT) was initiated if >3 metastases were detected or if patients became symptomatic. Kaplan-Meier statistics were applied. Results. Clavien-Dindo grade 1, 2, 3a, and 3b complications were seen in 6, 1, 1, and 2 patients, respectively. Median follow-up time was 22 months. Among 13 patients treated for oligometastatic disease, 8 (67%) had a PSA decline, with 3 patients showing cBR. Median PSA progression-free survival (FS) was 4.1 months and median CP-FS 7 months. Three patients started ADT, resulting in a 2-year ADT-FS rate of 79.5%. Conclusion. SLND is feasible, but postoperative complication rate seems higher than that for primary LND. Biochemical and clinical response duration is limited, but as part of an oligometastatic treatment regime it can defer palliative ADT.
Highlights
Introduction and ObjectivesPrimary treatments for localized prostate cancer (PC) are provided for optimistic oncological results, with even highrisk patients obtaining a 10-year cancer specific survival of 90% [1]
We present our series of salvage pelvic lymph node dissection (SLND), performed mostly with minimally invasive surgical techniques, in which we weigh the surgical morbidity against a potential oncological benefit, without the effect of adjuvant therapies
Three patients suffered transient penile or scrotal edema, 2 had a temporary loss of sensation in the genitofemoral nerve dermatome, and 1 showed prolonged ileus after surgery. Of those requiring further treatment, one patient was admitted for antibiotic treatment because of a hospital-acquired pneumonia and 3 patients underwent additional interventions to cope with surgical complications: one patient had a percutaneous drainage of a lymphocele and received anticoagulants for a deep venous thrombosis; another presented with partial bladder necrosis demanding transurethral resection; a lymphocele with abscedation needed to be surgically drained under general anesthesia
Summary
Primary treatments for localized prostate cancer (PC) are provided for optimistic oncological results, with even highrisk patients obtaining a 10-year cancer specific survival of 90% [1] These outcomes are accompanied by a significant number of patients presenting with biochemical recurrence after primary treatment, indicating the presence of prostatic epithelial tissue. These 20–50% of cases that do progress with a rise in PSA might show reduced cancerspecific survival rates [2,3,4] Advanced imaging techniques, such as magnetic resonance imaging (MRI) and choline positron emission tomography (PET) combined with computed tomography (CT), aim to detect recurrent disease in as early as possible stage [5]. Limited spread of disease, often referred to as oligometastatic disease, has been associated with better oncological prognosis [6, 8, 9]
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