[Salvage lymphadenectomy for recurrent prostate cancer]

Prostate-specific membrane antigen (PSMA)-based positron emission tomography (PET) imaging allows early detection of metastases in patients with biochemical recurrence. Salvage lymphadenectomy became a widely used method of metastasis-directed treatment. Retrospective analyses show that a low prostate-specific antigen (PSA) value and presence of no more than two affected lymph nodes within the pelvis are factors associated with a good outcome. In all, 40-80% of patients achieve a complete biochemical response with a mean time without biochemical recurrence of 8 months and a prolonged treatment-free interval. About 10% of patients with a complete biochemical response will live without recurrence after 10 years. The utilization of PSMA-radioguided surgery increases the likelihood of intraoperative detection of suspicious affected lymph nodes. Complications can mostly be avoided by prudent patient selection and surgical expertise.