You have accessJournal of UrologyProstate Cancer: Advanced II1 Apr 2015MP82-03 SALVAGE LYMPH NODE DISSECTION FOR CLINICALLY RECURRENT PROSTATE CANCER: WHICH PATIENTS DO BENEFIT FROM THIS APPROACH? Nazareno Suardi, Giorgio Gandaglia, Marco Bianchi, Ettore Di Trapani, Alessandro Nini, Vito Cucchiara, Walter Cazzaniga, Stefano Luzzago, Marta Picozzi, Roberto Bertini, Francesco Montorsi, and Alberto Briganti Nazareno SuardiNazareno Suardi More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Marco BianchiMarco Bianchi More articles by this author , Ettore Di TrapaniEttore Di Trapani More articles by this author , Alessandro NiniAlessandro Nini More articles by this author , Vito CucchiaraVito Cucchiara More articles by this author , Walter CazzanigaWalter Cazzaniga More articles by this author , Stefano LuzzagoStefano Luzzago More articles by this author , Marta PicozziMarta Picozzi More articles by this author , Roberto BertiniRoberto Bertini More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.522AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Salvage pelvic/retroperitoneal lymph node dissection (sLND) might delay clinical recurrence and postpone the use of systemic therapies in patients with biochemical progression (BCR) and nodal recurrence from prostate cancer (PCa). However, it is not clear which patients benefit most from this approach. We analyzed a large series of patients submitted to pelvic/retroperitoneal sLND in order to identify optimal candidates for this treatment modality. METHODS Between 2002 and 2014, 119 patients were submitted to pelvic and/or retroperitoneal sLND for biochemical recurrence (BCR) after radical prostatectomy for pelvic and/or retroperitoneal nodal uptake at 11CCholine PET/CT scan at a single center. Biochemical response (BR) to treatment was defined as PSA <0.2 ng/ml at 40 days after salvage LND. Clinical recurrence (CR) was defined as the presence of positive findings at bone scan and/or 11CCholine PET/CT scan after sLND. Kaplan-Meier analyses addressed time to BCR and CR after salvage LND. Multivariable regression analyses identified patients who developed CR within 2 years after sLND. RESULTS Median follow-up after LND was 48.0 months. Overall, 37 (43%) of patients achieved BR. The 5-year BCR free-survival in patients with BR rate was 48.8%. The 5-year cancer-specific and CR free-survival rates were 86.8 and 28.6%, respectively. The 5-year CR-free survival rates after sLND were 50.2% in patients with BR vs. 13.1% in patients where BR was not achieved (p<0.001). Clinical recurrence was deferred for 2 or more years in 53.2% of patients. Patients with CR within 2 years after surgery showed lower 5 year-CSM-free survival rates as compared to patients free of CR at 2 years (70.8 vs. 94.0%, respectively; p=0.03). At multivariable analyses, PSA >4ng/ml (OR: 3.65; p=0.04) and a history of radiation therapy after RP (OR: 6.69; p=0.01) were associated with higher risk of early clinical recurrence, after accounting for the site of positive PET/CT scan, time to BCR after RP and pN status at RP. CONCLUSIONS We report the largest series of sLND for nodal recurrent PCa. A significant proportion of patients submitted to sLND show complete BR and approximately half of them remains BCR-free at 5 years of follow-up. Clinical recurrence is delayed of 2 or more years in roughly 50% of patients. Patients with PSA>4ng/ml and with a history of radiation therapy have a low change of delaying clinical progression. Therefore, caution should be used in managing such patients with sLND. These individuals might be candidates to other systemic therapeutic approaches. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1037-e1038 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nazareno Suardi More articles by this author Giorgio Gandaglia More articles by this author Marco Bianchi More articles by this author Ettore Di Trapani More articles by this author Alessandro Nini More articles by this author Vito Cucchiara More articles by this author Walter Cazzaniga More articles by this author Stefano Luzzago More articles by this author Marta Picozzi More articles by this author Roberto Bertini More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...