Salvage lymph node dissection in nodal oligorecurrent prostate cancer: literature review and our experience

Abstract

Background. Despite improved surgical techniques in treatment of prostate cancer, biochemical recurrence after surgery (increase in prostate-specific antigen level (PSA) by 0.2 mg/mL or higher in 2 consecutive measurements) develops in 20–40 % of patients depending on disease stage and tumor aggressiveness. To diagnose the source of biochemical recurrence, patients undergo positron emission tomography/computed tomography (PET/CT) with 18F- or 68Ga-labeled prostate-specific membrane antigen (PSMA). Both tracers showed comparable results in phase III trials with positive prognostic values between 84 and 92 % at PSA level ≥1 ng/mL. A number of articles has been published demonstrating the effectiveness of salvage lymph node dissection (SLND) after local treatment of carefully selected patients in the long-term. According to the results of these publications, drug therapy in patients with oligometastatic progression can be delayed by years and potentially increse overall survival.Aim. To analyze the literature and our own experience of SLND in treatment of nodal oligorecurrent prostate cancer.Materials and methods. At the Clinic of the Moscow City Oncological Hospital No. 62 between 2012 and 2023 in the frame-work of the clinical protocol, 32 patients with nodal oligorecurrent prostate cancer underwent SLND after radical prostatectomy: 12.5 % (4 of 32) of patients through open access, 87.5 % (28 of 32) through laparoscopic access.Results. Two groups were identified: 1st group (n = 20) of patients without androgen deprivation therapy (ADT) and/or external beam radiotherapy after SLND; 2nd group (n = 12) of patients receiving immediate ADT and/or external beam radiotherapy after SLND.In the 1st group, an additional criterion of SLND effectiveness was introduced, namely, PSA response: complete, partial PSA response, or its absence. In patients with partial PSA response (n = 4), its depth was evaluated; it varied between 16 and 83 %. PSA response depth did not correlate with duration of response.Complete PSA response was achieved in 60 % (n = 12) of patients. Duration of response varied between 3 and 133 months without additional treatment.In the 1st group, median follow-up was 6 months and progression-free survival was 18 months; in the 2nd group, median follow-up was 31 months and median progression-free survival was 41.9 months (p = 0.84456).Conclusion. The standard of treatment for patients with metastatic hormone-sensitive prostate cancer is ADT in combination with 2nd generation antiandrogens. Improvement and availability of PET/CT with PSMA allowed to identify patients with nodal oligorecurrent prostate cancer in which SLND without ADT allows to achieve complete PSA response in 60 % of cases and delay ADT associated with a number of adverse events. SLND is characterized by low number of postoperative complications, short hospital stay.