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

Patrizio Rigatti, Nazareno Suardi, Alberto Briganti, Luigi F. Da Pozzo, Manuela Tutolo, Luca Villa, Andrea Gallina, Umberto Capitanio, Firas Abdollah, Vincenzo Scattoni, Renzo Colombo, Massimo Freschi, Maria Picchio, Cristina Messa, Giorgio Guazzoni, Francesco Montorsi

Research output: Contribution to journalArticle

Abstract

Background: The management of patients with clinical recurrence of prostate cancer after radical prostatectomy (RP) remains challenging. Objective: To determine whether the removal of positive lymph nodes at [11C]choline positron emission tomography/computed tomography (PET/CT) scan may have an impact on the prognosis of patients with biochemical recurrence (BCR) and nodal recurrence after RP. Design, setting, and participants: Prospective analysis of 72 patients affected by BCR after RP associated with a nodal pathologic [11C]choline PET/CT scan. Intervention: Patients underwent salvage lymph node dissection (LND). Measurements: Biochemical response (BR) to treatment was defined as prostate-specific antigen (PSA) 4 ng/ml (HR: 2.13; p = 0.03) and the presence of retroperitoneal uptake at PET/CT scan (HR = 2.92; p = 0.004) represented independent preoperative predictors of CR. Similarly, the presence of pathologic nodes in the retroperitoneum (HR: 2.78; p = 0.02), higher number of positive lymph nodes (HR: 1.04; p = 0.006), and complete BR to salvage LND (HR: 0.31; p = 0.002) represented postoperative independent predictors of CR. Main limitations consisted of the lack of a control group and the heterogeneity of patients included in the analyses. Conclusions: Salvage LND is feasible in patients with BCR after RP and nodal pathologic uptake at [11C]choline PET/CT scan. Biochemical response after surgery can be achieved in a consistent proportion of patients. Although most patients invariably progressed to BCR after surgery at longer follow-up, 35% of patients showed the absence of CR at 5 yr.

Original languageEnglish
Pages (from-to)935-943
Number of pages9
JournalEuropean Urology
Volume60
Issue number5
DOIs
Publication statusPublished - Nov 2011

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Keywords

  • [11C]choline PET/CT
  • Biochemical recurrence
  • Lymph node dissection
  • Prostate cancer

ASJC Scopus subject areas

  • Urology

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