Salvage lymphadenectomy in postprostatectomy patients with prostate-specific antigen recurrence

Despite very good oncological outcomes provided by radical prostatectomy for organ-confined prostate cancer, up to 40% of patients develop a biochemical recurrence (BCR). BCR can be associated with local or distant recurrence of prostate cancer. However, it can be difficult to identify the exact site of recurrence based on traditional diagnostic imaging tools. The introduction of more advanced imaging studies, such as PET/computed tomography scan, has led to the possibility of identifying small sites of recurrence of prostate cancer. Therefore, once the exact site of recurrence has been identified, theoretically new treatment options might be introduced.

Few studies have addressed the possibility to perform a selective pelvic/retroperitoneal lymph node dissection in patients with BCR associated with the evidence of nodal uptake at PET/computed tomography scan. The results of such studies are conflicting, since some patients seem to benefit from the removal of recurrent lymph nodes, showing temporary prostate-specific antigen response to salvage surgery. On the other hand, other series showed no benefit for such patients related to this surgical approach. Moreover, the identification of the good candidates to salvage lymph node dissection is needed.

Few studies reported a partial or even a complete prostate-specific antigen response to salvage lymph node dissection in patients with nodal recurrence of prostate cancer. However, due to the small number of patients included, to the lack of control groups as well as to the short-term follow-up, to date the available data do not justify the use of this surgical approach out of clinical trials.