Salvage Pelvic Lymph Node Dissection in Recurrent Prostate Cancer: Surgical and Early Oncological Outcome

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.

Management of Node Only Recurrence after Primary Local Treatment for Prostate Cancer: A Systematic Review of the Literature

“…Nevertheless, a recent prospective study tended to show less frequent complications using minimally invasive techniques. 27 An interesting series by Rischke et al revealed that adjuvant RT resulted in delayed relapse in the treated field. 21 They compared oncologic outcomes between 46 patients treated only with sLND and 47 who received additional RT after sLND.…”

Evaluation of safety and advisability of salvage lymph node dissection in patients with lymphogenic metastases of prostate cancer after radical treatment

“…Согласно данным литературы СЛАЭ может являться эффективным и безопасным методом лечения хорошо отобранных пациентов с лимфогенным прогрессированием РПЖ [1,[8][9][10][11][12][13][14][15]. Частота развития хирургических осложнений в нашей серии наблюдений составила 58,8 %, что соответствует результатам других исследований.…”

“…Частота развития хирургических осложнений в нашей серии наблюдений составила 58,8 %, что соответствует результатам других исследований. В разных сериях наблюдений хирургические осложнения возникали в 0-90 % случаев и чаще были низкой (I-II по классификации Clavien-Dindo) степени тяжести [10,12,16,17]. Наиболее часто встречающиеся осложнения после выполнения СЛАЭ, описанные в литературе, -лимфорея, лихорадка и динамическая кишечная непроходимость.…”

“…Подобные результаты описывают T. Claeys и соавт. у 13 пациентов с лимфогенным прогрессированием РПЖ [10]. Медиана уровня ПСА перед выполнением СЛАЭ составила 2,1 (0,69- Диагностика и лечение опухолей мочеполовой системы.…”

Extended robotic salvage lymphadenectomy in patients with "node-only "prostate cancer recurrence: initial experience

“…The management of patients with recurrent PCa is challenging, 20–40% of patients relapse within 5 years and 25–30% progress to metastatic disease [ 5 ]. Ultrasound and computerized imaging methods until recently did not allow to accurately determine the presence and degree of lymphadenopathy.…”