INTRODUCTION AND OBJECTIVE:
With the advent of the 68-Ga PSMA PET/CT scan, recurrences following radical prostatectomy (RP) can be localized to pelvic lymph nodes, soft pelvic tissue, and/or distant metastases. In our experience, 55% of patients with a biochemical recurrence (BCR) following surgery recur locally in the pelvic lymph nodes (PLN). Standard therapies such as radiation and/or hormonal therapy are known to negatively affect patients’ quality of life (QOL) and, in this regard, the present study introduces salvage pelvic lymph node dissections (sPLND) of local recurrence as a potential treatment for local recurrences.
Following RP, 87 patients underwent 68 Gallium PSMA/PET CT scan, of which 64 scans were positive, with 35 (40.2%) demonstrating radiographic evidence of localized recurrence in the PLN. Amongst the PLN positive group, 15 patients proceeded with sPLND by a single surgeon. The primary outcome evaluated was PSA kinetics, and secondary outcome evaluated was need for secondary treatment.
All surgeries were completed outpatient without complication. Patients were discharged with <24 hours hospitalization with <1 week recovery time. Of the 15 patients who underwent sPLND, 6 (40.0%) patients had a stable rise in PSA with no secondary intervention at mean follow-up time of 2.3 (±0.8) years following sPLND. 4 (26.7%) patients experienced a stable rise in PSA with secondary intervention, and 5 (33.3%) patients experienced BCR immediately, with immediate hormonal therapy as a secondary intervention. In 10/15 (33.33%) of the patients, PSA decreased by an average of 58% following sPLND. 6/15 (40.0%) patients did not require secondary systemic interventions such as radiation and hormonal therapy thus far (Table 1).
This case series explores the utility of PSMA/PET scan imaging and subsequent dissection of pelvic lymph node recurrences, demonstrating its potential to slow PSA progression and delay or eliminate the need for secondary intervention. Future studies with additional patients and greater follow-up are required to evaluate PSA progression and secondary intervention post-sPLND further.
Source of Funding: