MAPPING PATTERNS OF RECURRENCE AFTER SALVAGE LYMPH NODE DISSECTION IN PATIENTS WITH METASTATIC PROSTATE CANCER

Abstract

Introduction

Salvage lymph node dissection represents one of the rescue treatment options for prostate cancer patients with lymph node recurrence. Nonetheless, patterns of recurrence after salvage lymph node dissection is not well stuided. As such, we thought to study patterns of recurrence in patients with oligometastatic disease identified through C11 choline PET imaging and treated with salvage lymph node dissection.

Methods

Utilizing the prospectively maintained C11 choline PET CT scan registry, we identified 116 patients who underwent salvage lymph node dissection for oligometastatic disease detected by C11 choline PET/CT. The salvage lymph node dissection procedures included a bilateral extended template. Recurrence sites following the procedure were classified into five categories: local recurrence, regional lymph node recurrence, non-regional lymph node recurrence, distant recurrence, and bone disease. The median follow-up duration was 90 months.

Results

Table 1 presents the clinicopathological variables of the study cohort. Notably, 88% of the cohort had undergone radical prostatectomy as their primary treatment. The majority of patients had 1-2 pathology-proven metastases on C11 choline PET-CT prior to salvage lymph node dissection. Regional lymph nodes were the predominant site of pre-salvage oligometastatic disease, accounting for 70% of cases. Figure 1 illustrates the sites of disease recurrence following salvage lymph node dissection. Regional lymph nodes were the most common site of recurrence, followed by bone disease, non-regional lymph nodes, local recurrence, and distant lymph node metastases. The median time to biochemical recurrence after salvage lymph node dissection was approximately 9 months.

Conclusions

Salvage lymph node dissection constitutes one of the salvage treatment options for patients with oligometastatic disease. Presents of recurrence after salvage lymph node dissection is anatomically diverse with regional lymph node represents the most common site of disease recurrence. This findings have implications for guiding subsequent salvage treatment options after salvage lymph node dissections.