Salvage surgery for nodal recurrent prostate cancer

To critically review the currently available literature regarding detection of nodal recurrent prostate cancer (PCa) and to examine the role of salvage lymph node dissection (SLND).

The introduction of novel imaging modalities such as prostate-specific membrane antigen PET/computed tomography in the management of nodal recurrent PCa have increased the accuracy of lymph node metastases detection for SLND planning. Clinical evidences showed that preoperative selection of patients according to pathological stage, Gleason score, and prostate-specific antigen may increase the chance of biochemical response and even possibly decrease the risk of disease recurrence after SLND. Particularly, about half of patients treated with SLND will have an immediate complete postoperative biochemical response, and will remain free of clinical recurrence for 5 years. Finally, some authors suggested a role of SLND even for castration-resistant PCa where surgery may delay the use of systemic therapies.

SLND is being evaluated in the management of nodal recurrent PCa in the recent years. Need to avoid established role as this is an experimental therapy, not supported by prospective data and not a standard option, where the only prospective randomized trial evaluating its utility is currently ongoing.