Extended Salvage Pelvic Lymph Node Dissection in Patients with Recurrent Prostate Cancer

Aksenov, Alexey V.; Boller, A.; Kalz, Almut; Heimann, Diana; Janßen, Isa; Jünemann, Klaus-Peter

doi:10.1155/2014/321619

Cited by 12 publications

(14 citation statements)

References 17 publications

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“…Pelvic Lymph Node Dissection.-Pelvic lymph node dissection (PLND) is still the most precise method for diagnosing nodal metastases, with the advantage of possibly yielding a therapeutic benefit (24). Although the classification and anatomic delimitation of PLND templates differ among institutions (25), PLND can generally be performed by following a standard template (ie, external iliac nodes up to the ureteral crossing, internal iliac nodes, and obturator nodes) or extended template (ie, standard template plus cranially up to the para-aortic nodes and caudally to the femoral channel nodes/Cloquet node and presacral nodes (26).…”

Section: Seminal Vesicles and Ducti Deferentia-al-mentioning

confidence: 99%

Revisiting Prostate Cancer Recurrence with PSMA PET: Atlas of Typical and Atypical Patterns of Spread

et al. 2019

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The introduction of prostate-specific membrane antigen (PSMA) in clinical practice has revolutionized evaluation of biochemical recurrence of prostate cancer after curative-intent treatment. The high expression of this glycoprotein in prostate cancer cells makes PSMA imaging superior to the current conventional staging methods, namely bone scanning and CT. The high capability of PSMA imaging for identifying very small previously undetected lesions has been widely demonstrated in the literature, leading to a rethinking of patient management by oncologists, urologists, and radiation oncologists. The typical and predictable patterns of spread in prostate cancer are still more prevalent, such as spread to pelvic lymph nodes and bone metastasis, but different patterns of disease spread are becoming more commonly recognized with higher reliability because PSMA imaging allows detection of more typical and atypical lesions than conventional imaging. Furthermore, it is important for the reading physician to recognize and understand the typical disease spread and the most prevalent atypical prostate cancer relapses, not only to heighten the relevancy of reports but also to improve imaging consultancy in multispecialty oncologic practice. ©

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Section: Seminal Vesicles and Ducti Deferentia-al-mentioning

confidence: 99%

Revisiting Prostate Cancer Recurrence with PSMA PET: Atlas of Typical and Atypical Patterns of Spread

et al. 2019

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“…We performed salvage ePLND according to the surgical template developed at our department [ 13 ]. The surgical regions of the Kiel template are defined as follows: (1) para-aortic LNs; (2) LNs along the common iliac artery; (3) LNs along the external iliac artery; (4) LNs along the internal iliac artery; (5) LNs in the Marcille’s triangle; (6) obturator LNs; and (7) presacral LNs.…”

Section: Methodsmentioning

confidence: 99%

Cancer-specific and overall survival in patients with recurrent prostate cancer who underwent salvage extended pelvic lymph node dissection

et al. 2016

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BackgroundThe aim was to evaluate cancer-specific survival (CSS) and overall survival (OS) in patients with prostate cancer (PCa) recurrence who underwent salvage extended pelvic lymph node dissection (ePLND), taking into consideration pre- and postoperative androgen deprivation therapy (ADT).MethodsSalvage ePLND was performed in a cohort of 54 patients with PCa recurrence, and data from 45 patients were analyzed. The indications for salvage ePLND were biochemical recurrence (BCR) of PCa and suspect findings on 11C-choline PET/CT. PSA-level, biochemical response (BR), duration of biochemical recurrence freedom (BCRF), number of metastases, OS and CSS were analyzed retrospectively.ResultsThe average follow-up was 42.7 ± 20.8 months. Thirty-three patients (73.3 %, 95 % CI: 60.5–83.6 %) achieved BCRF during follow-up. The mean BCRF-period was 31.4 ± 19.7 months. CSS and OS were both 91.7 % ± 4.8 % (3-year survival) and 80.6 ± 8.6 % (5-year survival). Twenty-four patients (53.3 %, 95 % CI: 40.0–66.3 %) with castration-resistant PCa (CRPC) responded again to ADT after salvage ePLND.ConclusionsSalvage ePLND for selected patients with BCR and clinically recurrent nodal disease can achieve an immediate complete PSA response (i. e. BCRF) in nearly half of the patients. Patients with CRPC responded again to ADT after ePLND. Multicenter prospective studies with a control group are needed.

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“…This study is a retrospective analysis of case histories. The patients suffered a relapse of PCa, which was treated at our institution by salvage extended lymph node dissection (sELND) according to the “Kiel Template” between 2004 and 2012 (Osmonov et al 2014 ).…”

Section: Methodsmentioning

confidence: 99%

Sensitivity and specificity of PET/CT regarding the detection of lymph node metastases in prostate cancer recurrence

et al. 2014

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BackgroundThe aim of the study is to assess the efficacy of choline PET/CT regarding the detection of lymph node (LN) metastases in recurrent prostate cancer (PCa).Methods49 patients with a biochemical recurrence of PCa (PSA >0.2 ng/ml) were included in the study. All patients were selected for further diagnostics with a choline-PET/CT. All patients underwent salvage extended lymphadenectomy. The PET/CT result and the histological findings were analyzed regarding the specificity and sensitivity and with respect to the localization of the metastases. The detection rate of LN metastases was analyzed with respect to interdependencies between the pre-PET/CT PSA-value as well as the role of prior ADT.Results41 out of 49 (83.6%) patients showed positive PET/CT results. Positive LNs were found in 27 out of 49 patients (55.1%). 48.9% of the PET-CT-findings proved true positive, 36.7% were found to be false positive. 8.1% proved true negative and 8.1% false negative. This results in a specificity of 22.7% and a sensitivity of 85.1%. Out of the true positive PET/CT scans, 61.9% were not congruent regarding the localization of positive LNs. In patients with PSA [greater than or equal to] 5 ng/ml, the sensitivity of the PET/CT result was 93.7%, while specificity was 0%. In 24 patients who underwent ADT prior to the PET/CT diagnostics, the sensitivity was 84.6% and specificity 9.0%.ConclusionsThe reliability of PET/CT imaging for detection of LN metastases is limited by a high false-positive rate. The influence of ADT further diminishes the PET/CT reliability. Sensitivity of the PET/CT is highest in patients with a PSA of [greater than or equal to] 5 ng/ml. Based on our results, we propose the following conclusions: 1. There is no well-established diagnostic alternative to Choline-PET/CT Scan. Therefore this method may continue to be performed in patients with BCR. 2. It is not sufficient to remove only those LNs that show up in the PET/CT. 3. Salvage extended lymphadenectomy should follow a predefined template (e.g. the “Kiel template”) and not just the PET/CT scan results.

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Extended Salvage Pelvic Lymph Node Dissection in Patients with Recurrent Prostate Cancer

Cited by 12 publications

References 17 publications

Revisiting Prostate Cancer Recurrence with PSMA PET: Atlas of Typical and Atypical Patterns of Spread

Revisiting Prostate Cancer Recurrence with PSMA PET: Atlas of Typical and Atypical Patterns of Spread

Cancer-specific and overall survival in patients with recurrent prostate cancer who underwent salvage extended pelvic lymph node dissection

Sensitivity and specificity of PET/CT regarding the detection of lymph node metastases in prostate cancer recurrence

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