Complete PSA Remission without Adjuvant Therapy after Secondary Lymph Node Surgery in Selected Patients with Biochemical Relapse after Radical Prostatectomy and Pelvic Lymph Node Dissection

Abstract

Introduction. To evaluate whether secondary resection of lymph node (LN) metastases (LNMs) can result in PSA remission, we analysed the PSA outcome after resection of LNM detected on PET/CT in patients with biochemical failure. Materials and Methods. 11 patients with PSA relapse (mean 3.02 ng/mL, range 0.5–9.55 ng/mL) after radical prostatectomy without adjuvant therapy were included. Suspicious LN (1–3) detected on choline PET/CT and nearby LN were openly dissected (09/04–02/11). The PSA development was examined. Histological and PET/CT findings were compared. Results. 9 of 10 patients with histologically confirmed LNM showed a PSA response. 4 of 9 patients with single LNM had a complete permanent PSA remission (mean followup 31.8, range 1–48 months). Of metastasis-suspicious LNs (14) 12 could be histologically confirmed. The additionally removed 25 LNs were all correctly negative. Conclusions. The complete PSA remissions after secondary resection of single LNM argue for a feasible therapeutic benefit without adjuvant therapy. For this purpose the choline PET/CT is in spite of its limitations currently the most reliable routinely available diagnostic tool.

Sentinel lymph node dissection in more than 1200 prostate cancer cases: Rate and prediction of lymph node involvement depending on preoperative tumor characteristics

“…28 Additionally, the complete PSA remission after secondary resection of single LN metastases argues for a feasible therapeutic benefit. 29 Still, further data are awaited.…”

FROGG high‐risk prostate cancer workshop: Patterns of practice and literature review. Part II post‐radical prostatectomy

“…Traditionally, lymph node metastases have been considered a harbinger of distant, and hence incurable, metastatic disease with the standard of care in the post‐operative setting being ADT monotherapy, based on one small randomised trial. 27 However, there is accumulating evidence that durable biochemical and clinical control can be achieved in well‐selected node positive patients with aggressive loco‐regional management …”

“…27 However, there is accumulating evidence that durable biochemical and clinical control can be achieved in wellselected node positive patients with aggressive locoregional management. [27][28][29][30][31][32] A retrospective review of 250 patients with histologically proven LNI treated with RP, ePLND, adjuvant ADT and ART found that on multivariate analysis, ART was associated with an improvement in bPFS and cancerspecific survival. 33 A second study performed a matched pair analysis of patients with LNI treated with RP, ePLND and adjuvant ADT with or without ART.…”

Molecular and Functional Imaging for Detection of Lymph Node Metastases in Prostate Cancer

“…Limited or isolated lymph node metastases detected with molecular and functional imaging techniques may be treated with focal therapy. First reports on 11C-choline guided surgery show encouraging results [60,61], as is the case for 11C-choline guide robotic image-guided stereotactic radiotherapy [62]. …”