Outcomes of salvage lymph node dissection for oligmetastatic recurrent prostate cancer after radical prostatectomy: Results of a single-institution multidisciplinary team series

Background - Despite primary treatment of localized prostate cancer with surgery or radiotherapy, a significant number of patients will eventually develop biochemical recurrence. To date, small metastatic foci have been difficult to characterize using standard imagingmodalities. prostate-specific membrane antigen (PSMA) positron emission tomography (PET) has recently been introduced to allow for early detection. Prostate cancer lymph node metastatic recurrence is commonly managed with either radiation therapy or androgen-deprivation therapy. Surgical lymph node dissection has been recently trialed as an alternative option in select patients. Objective - To assess the outcomes of salvage lymph node dissection in patients who had detectable lesions on PSMA PET and relapse oligometastatic prostate cancer (CaP) post radical retropubic prostatectomy treated with salvage lymph node dissection. Design, setting, participants - We retrospectively reviewed records of patients treated with salvage lymph node dissection for oligometastatic CaP from the Princess Alexandra Hospital Prostate Cancer Multidisciplinary Team meeting. Biochemical response is defined as a biochemical reduction in rostatespecific antigen after surgery. Intervention - Pelvic LND Outcome measurements and statistical analysis - Over 12 months, 96 patients had PSMA imaging, 42 had PET MRI, 60 had PET CT), 66 were for biochemical recurrence, and 48 patients had oligometastatic disease. Conclusions - Patient selective salvage LND may be a useful alternative therapeutic option for patients with oligometastatic recurrence. Roughly 60% of patients achieved biochemical response.