The role of salvage extended lymph node dissection (LND) in patients with rising PSA and PET/CT scan detected nodal recurrence of prostate cancer.

Abstract

242 Background: According to the risk constellation recurrence rate of prostate cancer following local therapy is up to 60%. Early salvage radiotherapy already showed a benefit in progression-free survival. We analyzed the impact of salvage extended lymph node dissection on cancer control in patients with rising PSA and nodal recurrence in PET/CT scan. Methods: Between 2003 and 2015 we performed a salvage extended lymph node dissection in 95 patients with rising PSA and nodal recurrence in PET/CT scan after previous local therapy for prostate cancer. The extent of resection field was adjusted to the pre-operative imaging. Results: We identified 95 patients with rising PSA and nodal recurrence in PET/CT scan with a mean age of 66 years (55-76 years). There were no significant intraoperative complications. Postoperatively, 12% had Clavien/Dindo grade 3 complications. Complete PSA response, defined as a postoperative PSA level < 0.2 ng/ml, was diagnosed in 36% of patients. With a median follow-up of 19 months (1-101 months) cancer-specific mortality rate was less than 1%. Median progression-free survival was 7 months (1-43 months). The interval until the initiation of systemic treatment was 12 months (1-43 months). Conclusions: Salvage LND can be performed without significant complications. Immediate complete PSA response can be achieved in one third of patients and systemic therapy can be delayed by one year. For a general treatment recommendation individual predictive markers are currently still missing.