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Salvage lymphadenectomy in recurrent prostate cancer: is there evidence of real benefit?

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Abstract

Purpose

Nodal recurrent prostate cancer (PCa) after primary radical treatment represents a heterogeneous entity with many treatment options. In some cases, surgical removal of metastatic nodes seems to improve cancer control and delay systemic treatments. The objectives of this study were to analyze the available literature on salvage lymphadenectomy for the treatment of nodal recurrent PCa and to elucidate the real oncological benefit deriving from this procedure.

Methods

A PubMed search was performed using the following terms: prostate cancer, metastatic, oligometastatic, salvage lymphadenectomy, salvage lymph node dissection, salvage lymph node excision, and cytoreductive surgery. We included in the study all papers on salvage lymphadenectomy in nodal recurrent PCa, with no temporal limits. In addition, several papers addressing cytoreductive surgery and the biology of oligometastatic disease, published in different medical and basic research journals, were included.

Results

Salvage lymphadenectomy is still characterized by a lack of standardization in patient selection and surgical template. Its primary objectives are to prolong progression-free survival and to delay the need for systemic therapy. The improvements in preoperative imaging techniques in conjunction with the wide use of minimally invasive surgery have generated growing interest in this procedure.

Conclusion

Salvage lymphadenectomy is a promising treatment approach; however, its real oncological benefit is still far from proven. Prospective randomized trials need to be designed to improve understanding of this issue.

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References

  1. Mohler JL, Antonarakis ES, Armstrong AJ et al (2019) Prostate cancer, version 2.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 17(5):479–505. https://doi.org/10.6004/jnccn.2019.0023

    Article  PubMed  Google Scholar 

  2. Ost P, Bossi A, Decaestecker K et al (2015) Metastasis-directed therapy of regional and distant recurrences after curative treatment of prostate cancer: a systematic review of the literature. Eur Urol 67:852–863

    Article  Google Scholar 

  3. Giovacchini G, Picchio M, Gracia-Parra R et al (2014) [11C]Choline PET/CT predicts prostate cancer-specific survival in patients with biochemical failure during androgen deprivation therapy. J Nucl Med 55:233–241

    Article  CAS  Google Scholar 

  4. Heidenreich A, Bastian PJ, Bellmunt J et al (2014) EAU guidelines on prostate cancer. Part II: Treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol 65:467–479

    Article  CAS  Google Scholar 

  5. Phillips B, Ball C, Sackett D et al (2009) Oxford Centre for Evidence-Based Medicine - Levels of Evidence. http://www.cebm.net/index.aspx?o=1025

  6. Heldenreich A, Moul JW, Shariat SF et al (2016) Role of salvage lymph node dissection in prostate cancer. Curr Opin Urol 26:581–589

    Article  Google Scholar 

  7. Froehner M (2011) Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer 117:2577 (author reply 2577–8)

    Article  Google Scholar 

  8. Sivaraman A, Benfante N, Touijer K et al (2018) Can pelvic node dissection at radical prostatectomy influence the nodal recurrence at salvage lymphadenectomy for prostate cancer? Investig Clin Urol 59:83–90

    Article  Google Scholar 

  9. Han M, Partin AW, Pound CR, Epstein JI, Walsh PC (2001) Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15-year Johns Hopkins experience. Urol Clin N Am 28:555–565

    Article  CAS  Google Scholar 

  10. Suardi N, Gandaglia G, Gallina A et al (2015) Long-term outcomes of salvage lymph node dissection for clinically recurrent prostate cancer: results of a single-institution series with a minimum follow-up of 5 years. Eur Urol 67:299–309

    Article  Google Scholar 

  11. Abdollah F, Briganti A, Montorsi F et al (2015) Contemporary role of salvage lymphadenectomy in patients with recurrence following radical prostatectomy. Eur Urol 67:839–849

    Article  Google Scholar 

  12. Rigatti P, Suardi N, Briganti A et al (2011) Pelvic/retroperitoneal salvage lymph node dissection for patients treated with radical prostatectomy with biochemical recurrence and nodal recurrence detected by [11C]choline positron emission tomography/computed tomography. Eur Urol 60:935–943

    Article  Google Scholar 

  13. Brassetti A, Proietti F, Pansadoro V et al (2018) Oligometastatic prostate cancer and salvage lymph node dissection: systematic review. Minerva Chir. https://doi.org/10.23736/s0026-4733.18.07796-9

    Article  PubMed  Google Scholar 

  14. Abreu A, Fay C, Park D et al (2017) Robotic salvage retroperitoneal and pelvic lymph node dissection for ‘node-only’ recurrent prostate cancer: technique and initial series. BJU Int 120:401–408

    Article  Google Scholar 

  15. Montorsi F, Gandaglia G, Fossati N et al (2017) Robot-assisted salvage lymph node dissection for clinically recurrent prostate cancer. Eur Urol 72:432–438

    Article  Google Scholar 

  16. Treglia G, Ceriani L, Sadeghi R et al (2014) Relationship between prostate-specific antigen kinetics and detection rate of radiolabelled choline PET/CT in restaging prostate cancer patients: a meta-analysis. Clin Chem Lab Med 52:725

    Article  CAS  Google Scholar 

  17. Mamede M, Ceci F, Castellucci P et al (2013) The role of 11C-choline PET imaging in the early detection of recurrence in surgically treated prostate cancer patients with very low PSA level < 0.5 ng/mL. Clin Nucl Med 38:342–345

    Article  Google Scholar 

  18. Scattoni V, Picchio M, Suardi N et al (2007) Detection of lymph-node metastases with integrated [11C] choline PET/CT in patients with PSA failure after radical retropubic prostatectomy: results confirmed by open pelvic-retroperitoneal lymphadenectomy. Eur Urol 52:423–429

    Article  Google Scholar 

  19. Mitchell CR, Lowe VJ, Rangel LJ et al (2013) Operational characteristics of (11)c-choline positron emission tomography/computerized tomography for prostate cancer with biochemical recurrence after initial treatment. J Urol 189:1308–1313

    Article  Google Scholar 

  20. Passoni NM, Suardi N, Abdollah F et al (2014) Utility of [11C]choline PET/CT in guiding lesion-targeted salvage therapies in patients with prostate cancer recurrence localized to a single lymph node at imaging: results from a pathologically validated series. Urol Oncol 32:38e9–16

    Google Scholar 

  21. Oderda M, Joniau S, Palazzetti A et al (2018) Is 11C-choline positron emission tomography/computed tomography accurate to detect nodal relapses of prostate cancer after biochemical recurrence? A multicentric study based on pathologic confirmation from salvage lymphadenectomy. Eur Urol Focus 4:288–293

    Article  Google Scholar 

  22. Mena E, Lindenberg ML, Shih JH et al (2017) Clinical impact of PSMA-based 18F-DCFBC PET/CT imaging in patients with biochemically recurrent prostate cancer after primary local therapy. Eur J Nucl Med Mol Imaging 45:4–11

    Article  Google Scholar 

  23. Mandel P, Tilki D, Chun FK et al (2018) Accuracy of 68Ga-prostate-specific membrane antigen positron emission tomography for the detection of lymph node metastases before salvage lymphadenectomy. Eur Urol Focus. https://doi.org/10.1016/j.euf.2018.07.025 (Epub ahead of print)

    Article  PubMed  Google Scholar 

  24. Porres D, Pfister D, Thissen A et al (2017) The role of salvage extended lymph node dissection in patients with rising PSA and PET/CT scan detected nodal recurrence of prostate cancer. Prostate Cancer Prostatic Dis 20:85–92

    Article  CAS  Google Scholar 

  25. Rauscher I, Maurer T, Beer AJ et al (2017) Value of 68 Ga-PSMA HBED-CC PET for the assessment of lymph node metastases in prostate cancer patients with biochemical recurrence: comparison with histopathology after salvage lymphadenectomy. J Nucl Med 57:1713–1719

    Article  Google Scholar 

  26. Siriwardana A, Thompson J, van Leeuwen PJ et al (2017) Initial multicentre experience of68gallium-PSMA PET/CT guided robot-assisted salvage lymphadenectomy: acceptable safety profile but oncological benefit appears limited. BJU Int 120:673–681

    Article  CAS  Google Scholar 

  27. Jilg CA, Rischke HC, Reske SN et al (2012) Salvage lymph node dissection with adjuvant radiotherapy for nodal recurrence of prostate cancer. J Urol 188:2190–2197

    Article  CAS  Google Scholar 

  28. Hanske J, Müller G, van Ophoven A et al (2018) De novo neurogenic bladder dysfunction after salvage lymph node dissection in patients with nodal recurrence of prostate cancer. Neurourol Urodyn 15:5. https://doi.org/10.1002/nau.23545 (Epub ahead of print)

    Article  Google Scholar 

  29. Evans JD, Jethwa KR, Ost P et al (2018) Prostate cancer-specific PET radiotracers: A review on the clinical utility in recurrent disease. Pract Radiat Oncol 8:28–39

    Article  Google Scholar 

  30. Ost P, Bossi A, Decaestecker K et al (2015) Metastasis-directed therapy of regional and distant recurrences after curative treatment of prostate cancer: a systematic review of the literature. Eur Urol 67:852–863

    Article  Google Scholar 

  31. Rinnab L, Mottaghy FM, Simon J et al (2008) [11C]Choline PET/CT for targeted salvage lymph node dissection in patients with biochemical recurrence after primary curative therapy for prostate cancer: preliminary results of a prospective study. Urol Int 81:191–197

    Article  Google Scholar 

  32. Karnes RJ, Murphy CR, Bergstralh EJ et al (2015) Salvage lymph node dissection for prostate cancer nodal recurrence detected by 11C-choline positron emission tomography/computerized tomography. J Urol 193:111–116

    Article  Google Scholar 

  33. Claeys T, Van Praet C, Lumen N et al (2015) Salvage pelvic lymph node dissection in recurrent prostate cancer: surgical and early oncological outcome. Biomed Res Int. https://doi.org/10.1155/2015/198543

    Article  PubMed  PubMed Central  Google Scholar 

  34. Tilki D, Mandel P, Seeliger F et al (2015) Salvage lymph node dissection for nodal recurrence of prostate cancer after radical prostatectomy. J Urol 193:484–490

    Article  Google Scholar 

  35. Zattoni F, Nehra A, Murphy CR et al (2016) Mid-term outcomes following salvage lymph node dissection for prostate cancer nodal recurrence status post-radical prostatectomy. Eur Urol Focus 2:522–531

    Article  Google Scholar 

  36. Herlemann A, Kretschmer A, Buchner A et al (2017) Salvage lymph node dissection after 68 Ga-PSMA or 18F-FEC PET/CT for nodal recurrence in prostate cancer patients. Oncotarget 8:84180–84192

    Article  Google Scholar 

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Acknowledgements

The authors declare that the development of the manuscript was not supported by an honorarium, a grant, or any other sources of support, including sponsorship or any material sources of support.

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Authors and Affiliations

  1. Department of Uro-Oncology, Fundació Puigvert, University of Barcelona, Carrer de Cartagena 340-350, 08003, Barcelona, Spain

    F. Pisano, J. M. Gaya, A. Breda & J. Palou

  2. Department of Urology, A.O. Città della Salute e della Scienza, Ospedale “Città della Salute e della Scienza-Molinette”, University of Turin, Corso Bramante 88, 10126, Turin, Italy

    F. Pisano

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  1. F. Pisano
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Contributions

Project development: JMG, AB, JP. Bibliographic search: FPF, JMG. Drafting of the manuscript: FP. Supervision: JP.

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Correspondence to F. Pisano.

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The study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Pisano, F., Gaya, J.M., Breda, A. et al. Salvage lymphadenectomy in recurrent prostate cancer: is there evidence of real benefit?. World J Urol 37, 1551–1556 (2019). https://doi.org/10.1007/s00345-019-02844-1

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  • DOI: https://doi.org/10.1007/s00345-019-02844-1

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