Role of salvage lymph node dissection in patients previously treated for prostate cancer: systematic review

Abstract

Prostate cancer is the most common invasive cancer in men. Radical prostatectomy (RP) is a definitive treatment option, but biochemical recurrence can reach 40%. Salvage lymphadenectomy is a relatively recent approach to oligometasis and has been rapidly diffused primarily due to improvement in imaging diagnosis and results showing possibly promising therapy. A systematic literature review was performed in March 2020, according to the PRISMA statement. We excluded studies with patients with suspicion or confirmation of visceral and / or bone metastases. A total of 27 articles were included in the study. All studies evaluated were single arm, and there were no randomized studies in the literature. A total of 1,714 patients received salvage lymphadenectomy after previous treatment for localized prostate cancer. RP was the most used initial therapeutic approach, and relapses were based on PET / CT diagnosis, with Coline-11C being the most widely used radiopharmaceutical. Biochemical response rates ranged from 0% to 80%. The 5 years -Free Survival Biochemical recurrence was analyzed in 16 studies with rates of 0% up to 56.1%. The articles do not present high levels of evidence to draw strong conclusions. However, even if significant rates of biochemical recurrence are not evident in all studies, therapy directed to lymph node metastases may present good oncological results and postpone the onset of systemic therapy. The long-term impact in overall survival and quality of life, as well as the best strategies for case selection remains to be determined.

Diagnostic Performance of Preoperative Choline-PET/CT in Patients Undergoing Salvage Lymph Node Dissection for Recurrent Prostate Cancer: A Multicenter Experience

“…The median number of dissected LNs in our patients (10, interquartile range: 6-25) may be considered relatively low for a good salvage lymphadenectomy. Data from a recent systematic review indicate that other studies on patients undergoing SLND reported median numbers of dissected LNs between 6.5 and 83 [5]. While we reported that having undergone prior radiotherapy was not significantly associated with a reduced number of removed LNs in our patients, contrary to hypothetical expectations that intraoperative difficulties due to post-radiation scarring could have influenced the quality of SLND, having undergone prior extended lymphadenectomy with radical prostatectomy might have been a factor that had influenced the extent of salvage dissection (due to scarring and smaller amounts of remnant lymphatic tissue).…”

“…Biochemical recurrence (BCR) in prostate cancer (PC) patients managed with curative intent is being commonly encountered in clinical practice, as expected to occur in more than half of men with high-risk disease treated with radical prostatectomy (RP) [1]. In 82-91% of patients with BCR after RP, the location of recurrence is confined to the fossa or pelvic lymph nodes [2], making salvage lymph node dissection (SLND) a reasonable, yet still investigated treatment option in selected patients [3][4][5]. In patients fit for curative salvage treatment, a prostate specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) or choline PET/CT or fluciclovine PET/CT scan is recommended by the contemporary guidelines [6], in order to assess location of recurrence.…”

Pelvic lymph node dissection in high-risk prostate cancer

“…Nonetheless, the role of radical prostatectomy and PLND in patients with LNI remains unclear. Some authors argue that surgical treatment improves staging facilitating subsequent multimodal treatments (61) or postpone the onset of systemic therapy (62).…”

Editorial Comment: Embryological Development and Topographic Anatomy of Pelvic Compartments-Surgical Relevance for Pelvic Lymphonodectomy

“…The removal of pelvic lymph nodes is a important point during the radical prostatectomy and radical cystectomy. The extension of lymph node dissection is controversial and associated with more complications in post-operative period (1). In this interesting paper the topographic anatomy of pelvic compartments in relation to pelvic lymphonodectomy for rectal, uterine, and prostate cancer are reviewed.…”