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Salvage Lymph Node Dissection for Nodal Recurrence of Prostate Cancer after Radical Prostatectomy

2014; Lippincott Williams & Wilkins; Volume: 193; Issue: 2 Linguagem: Inglês

10.1016/j.juro.2014.08.096

1527-3792

Derya Tilki, Philipp Mandel, Flora Seeliger, Alexander Kretschmer, Alexander Karl, Süleyman Ergün, Michael Seitz, Christian G. Stief,

Urologic and reproductive health conditions

No AccessJournal of UrologyAdult Urology1 Feb 2015Salvage Lymph Node Dissection for Nodal Recurrence of Prostate Cancer after Radical Prostatectomy Derya Tilki, Philipp Mandel, Flora Seeliger, Alexander Kretschmer, Alexander Karl, Süleyman Ergün, Michael Seitz, and Christian G. Stief Derya TilkiDerya Tilki Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany Martini-Clinic Prostate Cancer Center and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany , Philipp MandelPhilipp Mandel Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany , Flora SeeligerFlora Seeliger Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany , Alexander KretschmerAlexander Kretschmer Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany , Alexander KarlAlexander Karl Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany , Süleyman ErgünSüleyman Ergün Institute of Anatomy and Cell Biology, University of Würzburg, Würzburg, Germany , Michael SeitzMichael Seitz Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany UroClinic Bogenhausen, Munich, Germany , and Christian G. StiefChristian G. Stief Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany View All Author Informationhttps://doi.org/10.1016/j.juro.2014.08.096AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We analyzed the impact of salvage lymph node dissection on the prognosis in patients with biochemical recurrence and positive lymph nodes on positron emission tomography/computerized tomography after radical prostatectomy. Materials and Methods: We retrospectively analyzed the records of 58 patients who underwent pelvic and/or retroperitoneal salvage lymph node dissection from June 2005 to February 2012. Biochemical response was defined as prostate specific antigen less than 0.2 ng/ml 40 days after salvage treatment. Biochemical recurrence in those with a biochemical response was defined as prostate specific antigen greater than 0.2 ng/ml and increasing. Kaplan-Meier curves were used to assess time to biochemical recurrence, clinical recurrence and cancer specific survival. Cox and binary logistic regressions were used to determine factors influencing clinical recurrence and biochemical response. Results: Median followup after salvage lymph node dissection was 39 months. A total of 13 patients (22.4%) achieved a biochemical response. Only 1 patient remained free of biochemical recurrence during followup. Clinical recurrence developed in 25 patients (48.1%) after salvage treatment. Six patients (10.3%) died of disease, including 4 with indeterminate extralymphatic findings on positron emission tomography/computerized tomography before salvage therapy. The 5-year cancer specific survival rate was 71.1%. Patients with a complete biochemical response showed a trend toward a longer time to clinical recurrence (p = 0.20). Biochemical response did not influence cancer specific survival. Conclusions: Salvage lymph node dissection in patients with biochemical recurrence and positive lymph nodes on positron emission tomography/computerized tomography led to a biochemical response in a certain proportion. Most patients progressed to biochemical recurrence after salvage treatment but almost half showed no further clinical recurrence. Cancer specific mortality occurred predominantly in patients with prior suspicion of extralymphatic lesions. Salvage lymph node dissection may delay androgen deprivation therapy and clinical recurrence in select patients. References 1 : Guidelines on Prostate Cancer. Arhem, The Netherlands: European Association of Urology2013. Google Scholar 2 : Guideline for the Management of Clinically Localized Prostate Cancer. Linthicum: American Urological Association2007. Google Scholar 3 : Natural history of biochemical recurrence after radical prostatectomy: risk assessment for secondary therapy. Eur Urol2007; 51: 1175. 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Google Scholar © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byTaneja S (2019) Re: Metastasis-Directed Therapy in Treating Nodal Oligorecurrent Prostate Cancer: A Multi-Institutional Analysis Comparing the Outcome and Toxicity of Stereotactic Body Radiotherapy and Elective Nodal RadiotherapyJournal of Urology, VOL. 203, NO. 3, (463-463), Online publication date: 1-Mar-2020.Rajarubendra N, Almeida F, Manojlovic Z, Ohe C, Ahmadi N, Cacciamani G, Qiu M, Abreu A, Cai J, Miranda G, Stern M, Carpten J, Kuhn P, Amin M, Gill P, Aron M and Gill I (2019) Histological Validation of 11Carbon-Acetate Positron Emission Tomography/Computerized Tomography in Detecting Lymph Node Metastases in Prostate CancerJournal of Urology, VOL. 201, NO. 2, (332-341), Online publication date: 1-Feb-2019.Cadeddu J (2018) Re: Robotic Salvage Retroperitoneal and Pelvic Lymph Node Dissection for 'Node-Only' Recurrent Prostate Cancer: Technique and Initial SeriesJournal of Urology, VOL. 199, NO. 4, (875-876), Online publication date: 1-Apr-2018.Ploussard G, Almeras C, Briganti A, Giannarini G, Hennequin C, Ost P, Renard-Penna R, Salin A, Lebret T, Villers A, Soulié M, de la Taille A and Flamand V (2015) Management of Node Only Recurrence after Primary Local Treatment for Prostate Cancer: A Systematic Review of the LiteratureJournal of Urology, VOL. 194, NO. 4, (983-988), Online publication date: 1-Oct-2015. Volume 193Issue 2February 2015Page: 484-490Supplementary Materials Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Keywordslymph node excisionprostatic neoplasmssalvage therapyprostatectomyprostate-specific antigenMetricsAuthor Information Derya Tilki Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany Martini-Clinic Prostate Cancer Center and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany Equal study contribution. More articles by this author Philipp Mandel Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany Equal study contribution. More articles by this author Flora Seeliger Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany More articles by this author Alexander Kretschmer Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany More articles by this author Alexander Karl Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany More articles by this author Süleyman Ergün Institute of Anatomy and Cell Biology, University of Würzburg, Würzburg, Germany More articles by this author Michael Seitz Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany UroClinic Bogenhausen, Munich, Germany Equal study contribution. More articles by this author Christian G. Stief Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany Equal study contribution. More articles by this author Expand All Advertisement PDF downloadLoading ...