Orlando, FL—Salvage extended pelvic lymph node dissection (ePLND) may be highly beneficial for selected prostate cancer patients with biochemical recurrence and clinically recurrent nodal disease, say German researchers.
ePLND may be able to achieve immediate complete PSA response and biochemical recurrence freedom in nearly 50% of patients, the researchers reported at the AUA annual meeting in Orlando, FL. Although 88.9% of patients received androgen deprivation therapy (ADT) postoperatively, the authors say adopting this approach may also help to postpone ADT and prolong biochemical-free survival without ADT. In addition, they found that patients with preoperatively hormone-resistant prostate cancers may again respond to ADT after ePLND.
The researchers, led by first author Daniar K. Osmonov, MD, of University Hospital Schleswig-Holstein in Kiel, Germany, conducted a retrospective single-center study that included 54 patients with recurrent prostate cancer. All of the patients underwent salvage ePLND between November 2003 and June 2012 based on biochemical recurrence and/or suspect findings on 11-choline positron emission tomography-computed tomography. The researchers were able to evaluate the postoperative course of the disease in 45 patients. They analyzed PSA levels, the duration of the biochemical recurrence-free period, and ADT use. They also looked at rates of bone metastases, risk factors of cancer-specific mortality, overall survival rates, and cancer-specific survival rates.
Thirty-six patients (80%) were hormone resistant and nine patients (20%) did not require ADT at all prior to salvage ePLND. However, after a mean 42.7 months following salvage ePLND, 40 patients (88.9%) received ADT. PSA levels dropped in 31 patients (68.9%) immediately after salvage ePLND. The mean duration of biochemical recurrence freedom after operation was 31.4 months.