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Salvage Lymph Node Dissection for Nodal Recurrent Prostate Cancer-Oncological Outcome from Long-term Follow-up
Ruth Himmelsbach1, Simon K B Spohn2, Anca-Ligia Grosu2
1Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Background And Objective:
Salvage lymph node dissection (sLND) in recurrent prostate cancer (PC) is still considered experimental due to limited prospective data and sparse long-term outcome reports. This study describes long-term oncological outcomes after sLND in PC patients with suspected lymph node metastases on positron emission tomography/computed tomography after primary therapy and aims to identify predictors for selecting patients who will benefit.
Methods:
Biochemical response (BR), biochemical recurrence (BCR), and clinical progression (CP) were assessed in 181 patients. Kaplan-Meier estimations served for time to BCR, CP, initiating androgen deprivation therapy (ADT), and overall survival (OS). Predictors were identified using binary logistic regression and Cox regression models.
Key Findings And Limitations:
The median follow-up was 70.1 mo (interquartile range 42.5-98.0). BR was achieved in 45% (82/181). According to Kaplan-Meier estimates, the 2-yr BCR- and CP-free survival rates were 32.4% and 51.2%, respectively. The 5-yr rates were 11.5% and 26%, respectively. At 2 yr after sLND, 83 of 181 patients had initiated ADT, while 82 remained at risk, corresponding to a Kaplan-Meier estimate of 51.5% without initiation of ADT. An incomplete BR and omission of radiotherapy (RT) after sLND were associated with increased risks of BCR (hazard ratio [HR] 3.29, p = 0.0001 and HR 1.55, p = 0.011, respectively) and CP (HR 2.83, p = 0.0001 and HR 1.59, p = 0.013, respectively). The time from initial therapy to nodal recurrence and a prostate-specific antigen (PSA) level of >2 ng/ml at sLND were associated with BCR. At the end of follow-up, 58% (105/181) had PSA levels below those at sLND. According to the Kaplan-Meier estimate, the 10-yr OS rate was 51.2%. Limitations are the retrospective design and a lack of a control group.
Conclusions And Clinical Implications:
Despite high BCR rates, over half of the patients were ADT free after 2 yr. Selected men with a low tumour burden may benefit from sLND, particularly in a multimodal treatment setting including RT.
