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Clinical Research

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

Prostate Cancer and Prostatic Diseases volume 20, pages 85–92 (2017)Cite this article

Subjects

Abstract

BACKGROUND:

Non-prostatic bed recurrence of prostate cancer (PCa) is usually treated with androgen deprivation therapy (ADT). We analyzed the impact of salvage extended lymph node dissection (sLND) on cancer control in patients with rising PSA and lymph node (LN) metastases.

METHODS:

Between 2009 and 2016 we performed sLND in 87 patients with biochemical recurrence (BCR) and positive LNs on 18FEC and 68Ga-PSMA positron emission tomography/X-ray computer tomography (PET/CT) after primary treatment (PT) of PCa. Intra- and postoperative complications according to Clavien-Dindo were assessed and the rates of biochemical response (BR), BCR-free and clinical recurrence (CR)-free survival, as well as time to initiation of systemic treatment were evaluated.

RESULTS:

Mean age of patients and mean PSA at sLND was 66.7 years (46–80 years) and 2.63 ng ml−1 (1.27–3.75 ng ml−1), respectively. With 87.4% radical prostatectomy (RP) was the most common PT. In all, 57.9% of patients additionally underwent adjuvant/salvage radiation therapy (RT) and 18.4% received ADT before sLND. Complete BR (cBR) was diagnosed in 27.5% of patients and incomplete BR in 40.6%. In total, 62.2% of patients remained without ADT at follow-up. With a median follow-up of 21 months (1–75 months), the cancer-specific mortality rate was 3.7%. The 3-year BCR-free, systemic therapy-free and CR-free survival rates for patients with cBR were 69.3%, 77.0% and 75%, respectively.

CONCLUSIONS:

sLND can be performed without significant complications and achieves an immediate BR, thus allowing a significant postponement of systemic therapy in selected patients with BCR and nodal recurrence of PCa. Therefore, sLND following 68Ga-PSMA PET/CT should be considered as part of a multimodal diagnostic and treatment concept for selective patients.

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Acknowledgements

We are grateful to Prof Dr rer medic Martin Hellmich (Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Germany) for his valuable support during statistical analysis.

Statement of human rights: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The present study is a retrospective one; for this type of study formal consent is not required.

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Author notes

  1. D Porres and D Pfister: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, University Hospital of Cologne, Cologne, Germany

    D Porres, D Pfister, A Thissen, T H Kuru, V Zugor & A Heidenreich

  2. Department of Pathology, University Hospital of Cologne, Cologne, Germany

    R Buettner

  3. Department of Pathology, RWTH University Hospital Aachen, Aachen, Germany

    R Knuechel

  4. Department of Nuclear Medicine, RWTH University Hospital Aachen, Aachen, Germany

    F A Verburg

  5. Department of Nuclear Medicine, University Hospital Gießen and Marburg, Marburg, Germany

    F A Verburg

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Correspondence to D Porres.

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Competing interests

D Porres has received consultancy fees, payment for speaker bureaus and travel support from Astellas, Bayer, Ipsen and Janssen and Novartis. D Pfister has received consultancy fees and payment for speaker bureaus from Astellas, Ipsen, Sanofi and Janssen. FAV is a consultant to Bayer and Genzyme. AH has received consultancy fees and payment for speaker bureaus from Amgen, Janssen, Ipsen, Sanofi and Takeda (for whom he is also a board member); research and travel support from Astellas; and a research grant from Sanofi. The remaining authors declare no conflicts of interest.

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Porres, D., Pfister, D., Thissen, A. et al. The role of salvage extended lymph node dissection in patients with rising PSA and PET/CT scan detected nodal recurrence of prostate cancer. Prostate Cancer Prostatic Dis 20, 85–92 (2017). https://doi.org/10.1038/pcan.2016.54

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