Salvage LND: Complete PSA response achievable

San Diego-Salvage lymph node dissection results in an immediate complete PSA response in about one-third of patients with rising PSA and nodal recurrence following local therapy for prostate cancer, according to German researchers.

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Although not a curative approach because most patients will show a biochemical recurrence, “systemic therapy and the associated side effects were delayed by more than 2 years in most of these patients,” first author Daniel Porres, MD, said at the 2016 AUA annual meeting in San Diego.

The recurrence rate after local therapy for prostate cancer is as high as 60%. Early salvage radiotherapy has already been shown to improve progression-free survival in patients with recurrence. Dr. Porres, from the department of urology at the University Hospital of Cologne, Germany, and colleagues set out to analyze the impact of salvage extended lymph node dissection on cancer control in patients with rising PSA and nodal recurrence on positron emission tomography (PET)/computed tomography scan.

They conducted a retrospective analysis of 95 patients (mean age, 66 years) who underwent salvage lymph node dissection following radical prostatectomy (n=78), electron beam radiation therapy (n=4), brachytherapy (n=4), and other forms of primary treatment (n=9) from 2003 to 2015 at two German institutions. Forty patients had salvage radiation therapy before salvage lymph node dissection.

The extent of the resection field was adjusted according to preoperative imaging, to include not only the PET-positive lymph nodes but also standard lymphadenectomy in the area of the common, external, and internal iliac artery plus the obturator fossa. “Twelve of the 95 patients underwent retroperitoneal lymphadenectomy,” said Dr. Porres.

The mean time between the primary treatment and salvage lymph node dissection was 55.08 months, with a range of 4 months to 209 months. There were no significant intraoperative complications. Postoperatively, 12% of patients had Clavien/Dindo grade 3 complications.

Next: Complete PSA response achieved in 36%

Complete PSA response achieved in 36%

The mean PSA level at salvage lymph node dissection was 3.57 ng/mL. A complete PSA response, defined as a postoperative PSA level <0.2 ng/mL, was achieved in 36% of patients.

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With a median follow-up of 19 months, the cancer–specific mortality was <1% and the median progression-free survival was 7 months (range,1 to 43 months). The mean interval to systemic therapy was 12 months, with a range of 1 to 43 months.

More data are needed to select patients adequately for salvage lymph node dissection, said Dr. Porres.

“For this analysis, we had lymph nodes positive up to the renal artery. In our institution, this is not the right candidate, so now we concentrate on lymph nodes in the pelvic area,” he said.

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