Salvage lymph node dissection for nodal recurrence of prostate cancer after radical prostatectomy

Abstract

Purpose: We analyzed the impact of salvage lymph node dissection on the prognosis in patients with biochemical recurrence and positive lymph nodes on positron emission tomography/computerized tomography after radical prostatectomy.

Materials and methods: We retrospectively analyzed the records of 58 patients who underwent pelvic and/or retroperitoneal salvage lymph node dissection from June 2005 to February 2012. Biochemical response was defined as prostate specific antigen less than 0.2 ng/ml 40 days after salvage treatment. Biochemical recurrence in those with a biochemical response was defined as prostate specific antigen greater than 0.2 ng/ml and increasing. Kaplan-Meier curves were used to assess time to biochemical recurrence, clinical recurrence and cancer specific survival. Cox and binary logistic regressions were used to determine factors influencing clinical recurrence and biochemical response.

Results: Median followup after salvage lymph node dissection was 39 months. A total of 13 patients (22.4%) achieved a biochemical response. Only 1 patient remained free of biochemical recurrence during followup. Clinical recurrence developed in 25 patients (48.1%) after salvage treatment. Six patients (10.3%) died of disease, including 4 with indeterminate extralymphatic findings on positron emission tomography/computerized tomography before salvage therapy. The 5-year cancer specific survival rate was 71.1%. Patients with a complete biochemical response showed a trend toward a longer time to clinical recurrence (p = 0.20). Biochemical response did not influence cancer specific survival.

Conclusions: Salvage lymph node dissection in patients with biochemical recurrence and positive lymph nodes on positron emission tomography/computerized tomography led to a biochemical response in a certain proportion. Most patients progressed to biochemical recurrence after salvage treatment but almost half showed no further clinical recurrence. Cancer specific mortality occurred predominantly in patients with prior suspicion of extralymphatic lesions. Salvage lymph node dissection may delay androgen deprivation therapy and clinical recurrence in select patients.

Keywords: lymph node excision; prostate-specific antigen; prostatectomy; prostatic neoplasms; salvage therapy.