Salvage Lymph Node Dissection with Adjuvant Radiotherapy for Nodal Recurrence of Prostate Cancer

• Published in: The Journal of urology Vol. 188; no. 6; pp. 2190 - 2197
• Main Authors: Jilg, C.A, Rischke, H.C, Reske, S.N, Henne, K, Grosu, A.-L, Weber, W, Drendel, V, Schwardt, M, Jandausch, A, Schultze-Seemann, W
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.2012; Elsevier
• Subjects: Aged; Biological and medical sciences; Gynecology. Andrology. Obstetrics; Humans; Lymph Node Excision; Male; Male genital diseases; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - radiotherapy; Neoplasm Recurrence, Local - surgery; Nephrology. Urinary tract diseases; positron-emission tomography and computed tomography; Prospective Studies; Prostate-Specific Antigen - blood; prostatic neoplasms; Prostatic Neoplasms - blood; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - surgery; Radiotherapy, Adjuvant; recurrence; Salvage Therapy; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; Urology; clinical progression; LN; RT; ART; LND; lymph node dissection; AHT; BR; radical prostatectomy; antihormonal treatment; PSA doubling time; computerized tomography; salvage therapy; PSA; positron-emission tomography and computed tomography; biochemical response; biochemical recurrence; prostate specific antigen; PSA-DT; CP; lymphadenectomy; PCA; recurrence; BCR; CT; lymph node excision; prostate cancer; LA; lymph node; prostatic neoplasms; radiotherapy; adjuvant radiotherapy; positron emission tomography; PET; RP; Radionuclide study; Prostate tumor; Nephrology; Relapse; Prostate disease; Adjuvant treatment; Urology; Lymphadenectomy; Surgery; Male genital diseases; Urinary system disease; Radiodiagnosis; Excision; Lymph node; Malignant tumor; Radiotherapy; Medical imagery; Computerized axial tomography; Salvage treatment; Prostate cancer; Positron emission tomography; Cancer; Emission tomography
• ISSN: 0022-5347; 1527-3792
• DOI: 10.1016/j.juro.2012.08.041

Purpose We evaluated the impact of salvage lymph node dissection with adjuvant radiotherapy in patients with nodal recurrence of prostate cancer. By default, nodal recurrence of prostate cancer is treated with palliative antihormonal therapy, which causes serious side effects and invariably leads to the development of hormone refractory disease. Materials and Methods A total of 47 patients with nodal recurrence of prostate cancer based on evidence of11 C-choline/18 F-choline (18 F-fluorethylcholine) positron emission tomography-computerized tomography underwent primary (2 of 52), secondary (45 of 52), tertiary (4 of 52) and quaternary (1 of 52) salvage lymph node dissection with histological confirmation. Of 52 salvage lymph node dissections 27 were followed by radiotherapy. Biochemical response was defined as a prostate specific antigen less than 0.2 ng/ml after salvage therapy. The Kaplan-Meier method, binary logistic regression and Cox regression were used to analyze survival as well as predictors of biochemical response and clinical progression. Results Mean prostate specific antigen at salvage lymph node dissection was 11.1 ng/ml. A mean of 23.3 lymph nodes were removed per salvage lymph node dissection. Median followup was 35.5 months. Of 52 salvage lymph node dissections 24 resulted in complete biochemical response followed by 1-year biochemical recurrence-free survival of 71.8%. Gleason 6 or less (OR 7.58, p = 0.026), Gleason 7a/b (OR 5.91, p = 0.042) and N0 status at primary therapy (OR 8.01, p = 0.011) were identified as independent predictors of biochemical response. Gleason 8–10 (HR 3.5, p = 0.039) as a preoperative variable, retroperitoneal positive lymph nodes (HR 3.76, p = 0.021) and incomplete biochemical response (HR 4.0, p = 0.031) were identified as postoperative predictors of clinical progression. Clinical progression-free survival was 25.6% and cancer specific survival was 77.7% at 5 years. Conclusions Based on11 C/18 F-choline positron emission tomography-computerized tomography as a diagnostic tool, salvage lymph node dissection is feasible for the treatment of nodal recurrence of prostate cancer. Most patients experience biochemical recurrence after salvage lymph node dissection. However, a specific population has a lasting complete prostate specific antigen response.