Extended robotic salvage lymphadenectomy in patients with ‘node-only’ prostate cancer recurrence: initial experience

INTRODUCTION: Biochemical relapse (BR) after a primary radical prostatectomy may occur in up to 40 percent of cases. Salvage lymphadenectomy has been proposed in patients with ‘node-only’ driven BR, following a definitive treatment of primary prostate cancer (PCa). We present our initial series of 10 consecutive patients who underwent an extended robotic salvage pelvic lymph node dissection (eRSPLND) for ‘node-only’ recurrent PCa. MATERIALS AND METHODS: It was a prospective study, including patients who presented with biochemical relapse after a primary radical prostatectomy at a median of 3.6 years prior. Clinical work-up that was done, including Magnetic resonance Imaging of chest/abdomen/pelvis and a bone scan, did not reveal any abnormalities. All patients underwent 11Choline PET (Positron Emission Tomography)/CT (Computed Tomography), which identified ‘node-only’ metastases. RESULTS: The median operative time was 73.4 mins, blood loss of 100 cc and hospital stay of 2 days. No patient had intra-operative complications, required an open conversion or any blood transfusion. Clavien II grade complications occurred in 1 patient (10%) and were managed conservatively. On histopathology, the median number of total and positive nodes per patient was 15 and 6, respectively. Overall, in our 10 patients, of the 157 total excised nodes, 38.8% were positive. Overall the median (range) PSA (prostate specific antigen) pre-operatively was 3.5 (1.6–3.7) ng/ml. At 3 months post-operatively, the median (range) PSA was 1.1 (0.2–3.4) ng/ml. This reflects an overall median PSA decrease of 31.4%. In no patient did the post-eRSPLND (extended Robotic Salvage pelvic lymphadenectomy) PSA reach zero. CONCLUSIONS: eRSPLND allows the majority of patients to postpone hormonal treatment, which can theoretically decrease the cost of the treatment. 11Choline PET/CT identifies patients who are suitable for the eRSPLND. Longer follow-up is necessary to assess the oncologic outcomes.