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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.

European Urology Focus

|December 11, 2025

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Salvage lymph node dissection (sLND) offers long-term oncological benefits for select recurrent prostate cancer (PC) patients. Over half of patients remained free from androgen deprivation therapy (ADT) after 2 years, suggesting sLND

Area of Science:

Urology
Oncology
Medical Imaging

Background:

Salvage lymph node dissection (sLND) for recurrent prostate cancer (PC) lacks extensive prospective data and long-term outcome reports.
PC patients with suspected lymph node metastases after primary therapy often undergo sLND.
This study evaluates long-term outcomes and predictors of benefit for sLND in PC.

Purpose of the Study:

To describe long-term oncological outcomes following sLND in PC patients.
To identify predictors for patient selection to maximize benefit from sLND.
To assess biochemical response, recurrence, progression, and survival after sLND.

Main Methods:

Retrospective analysis of 181 PC patients undergoing sLND.
Assessment of biochemical response (BR), biochemical recurrence (BCR), and clinical progression (CP).

Keywords:

Lymph node excision Metastasis-directed therapy Prostatic neoplasms Salvage therapy Treatment outcome

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Kaplan-Meier survival analysis and Cox regression for predictor identification.

Main Results:

Median follow-up was 70.1 months; 45% achieved BR.
2-year BCR-free and CP-free survival rates were 32.4% and 51.2%, respectively.
Incomplete BR and omission of radiotherapy (RT) increased BCR and CP risks. Time to nodal recurrence and PSA >2 ng/mL at sLND predicted BCR.

Conclusions:

Over half of patients remained androgen deprivation therapy (ADT)-free at 2 years post-sLND.
Selected men with low tumor burden may benefit from sLND, especially in multimodal settings including RT.
sLND can be a valuable option for specific recurrent prostate cancer cases.