Login to Access Video or Poster Abstract: MP97-16
Sources of Funding: none

Introduction

Salvage-lymphadenectomy (sLAD) is offered to patients with nodal-only recurrences after radical prostatectomy (RP). However, there is still controversy regarding appropriate patient selection for and oncological benefits from sLAD. Especially with the advent of ⁶⁸Ga-PSMA-PET/CT as a highly sensitive targeted imaging tool, the concept of sLAD seems to be a promising approach and evaluation of efficacy is needed.

Methods

We evaluated perioperative and oncological outcomes of patients with nodal-only recurrences after RP who underwent robotic sLAD at our institution. Recurrence was detected by targeted imaging (¹⁸F-Choline- or ⁶⁸Ga-PSMA-PET/CT).

Results

Data from 26 patients with a median age of 66.5 years [IQR 62;72] were analyzed with a median time from RP to sLAD of 40.1 months [IQR 14;61.5], median preoperative PSA 2.31 ng/ml [IQR 0.83;5.68]. Imaging of recurrence sites was performed with ¹⁸F-Choline-PET/CT in 11 and ⁶⁸Ga-PSMA-PET/CT in 15 patients, the majority of suspicious nodes were located around the iliac vessels (67%). Median operation time was 130.5min [IQR 118;170], median blood loss 35ml [IQR 10;100], median hospitalization time 3 days [IQR 3;4]. The median number of removed nodes was 7 [IQR 4;14] with a median of 1 [IQR 0;3,5] positive node. While in the first patients only suspicious lymph nodes were removed, an extended bilateral LAD was done in all patients from 2016 on (n=12). No major complications occurred. Postoperative PSA values were available for 21 patients (10 choline, 11 PSMA), relative PSA-changes from preoperative values are shown in the figure. Complete biochemical response (cBCR, postoperative PSA-nadir <0.2ng/ml) was observed in 6 patients. Median time from sLAD to initiation of systemic treatment was 5 months [IQR 3.3;13.2]._x000D_ _x000D_

Conclusions

Robotic sLAD is a viable treatment option with low morbidity that can be offered to patients with nodal-only recurrences after RP. Yet, cBCR is only observed in a minority of patients and virtually all patients will eventually have to undergo systemic treatment. Nonetheless, sLAD may at least delay the start of systemic therapy especially with the use of ⁶⁸Ga-PSMA-PET/CT, which showed very promising results in our series.

Funding

none