Salvage pelvic lymph node dissection for lymph node recurrent prostate cancer

The aim of this article is to update on the role of salvage pelvic lymph node dissection (SLND) for patients with lymph node-only recurrent prostate cancer (PCa) after radical prostatectomy.

Salvage lymph-node dissection represents a possible treatment option for selected patients with lymph-node only recurrent PCa detected by PET/CT. Although strong prospective evidence supporting its role is still missing, SLND is associated with encouraging oncological outcomes with 2-year biochemical progression-free survival ranging from 23 to 64%, and 5-year overall survival of 84%. However, the best oncological outcomes after SLND can only be reached with accurate patient election based on imaging and clinical features at the time of SLND. Finally, the use of the robotic approach for SLND is increasing, being associated with similar oncological outcomes but lower perioperative complication rates as compared with the open approach.

SLND represents a possible treatment option in lymph node only recurrent PCa, provided careful patient selection. It is likely that the introduction of novel imaging tracers and the use of a robotic approach will favourably impact on perioperative and oncological outcomes. Nevertheless, future randomized studies are awaited to confirm the effectiveness and utility of this experimental approach.