Login to Access Video or Poster Abstract: MP53-11
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Introduction

The role of salvage extended pelvic lymph node dissection (ePLND) in patients with prostate cancer (PCa) recurrence remains unclear due to the lack of long-term follow-up and survival data. The combination of surgical treatment methods with consecutive androgen deprivation therapy (ADT) as well as with new drugs makes it difficult to evaluate the impact of salvage ePLND alone on cancer specific survival (CSS) and overall survival (OS).

Methods

We are presenting a retrospective single-center study based on a cohort of 61 patients with biochemical recurrence (BCR) of PCa. In all patients, salvage ePLND was performed between November 2003 and February 2016. The indication for salvage ePLND was based on BCR of PCa and/or suspicious findings in 11C-PET/CT or later in 68Ga-PSMA-PET/CT. None of the patients had proven visceral or bone metastases at the time of salvage ePLND. Surgery was performed according to our standardized Kiel salvage template. We analyzed the dynamics of the PSA level, biochemical recurrence-free (BCRF) survival, OS and CSS and also took into consideration ADT as well as incidence of metastastic development.

Results

The mean follow-up was 60± 38 months (max 152, min 9); median follow-up was 59 months. The mean number of removed lymph nodes was 22.6. 40 (65.6%) patients were hormone-resistant prior to salvage ePLND; another 21 (34.4%) patients did not receive ADT at all prior to salvage ePLND. 52 (85.2%) of all patients received ADT after salvage ePLND. Immediately after salvage ePLND the PSA level dropped in 40 (65.6%) patients and reached a level below BCR cut-off in 14 (23.0%) patients. 39 (64.0%) patients had a BCR-free period during follow-up and in 24 (39.3%) patients this has continued until the time of analysis. The mean BCR-free survival was 42±34 months. The median BCR-free survival was 33 months. 9 (14.8%) patients died during the follow-up, 8 of them died from PCa metastases. In 4 (6.6%) patients BCR-freedom after salvage ePLND was achieved without ADT and still continues. 2 of these 4 patients also did not undergo ADT before salvage ePLND. 3- and 5-year CSS and OS were equal 93.9%±3.4% (3-year CSS and OS) and 88.2%±5.1% (5-year CSS and OS).

Conclusions

Salvage ePLND for selected patients with BCR and clinically recurrent nodal disease can lead to BCR-free survival in nearly 65% of the patients. Due to the PSA response after salvage ePLND, ADT can be started later in many patients. Moreover, patients with preoperatively hormone-resistant PCa respond again to ADT after salvage ePLND. Multi-central prospective studies with control groups are needed.

Funding

none