Salvage lymph node dissection in oligo-recurrent prostate cancer patients: Mapping patterns of recurrence and factors associated with disease progression.

BACKGROUND AND

OBJECTIVE

Salvage lymph node dissection (sLND) is a treatment for prostate cancer patients with lymph node recurrence. However, there is a lack of comprehensive data regarding subsequent patterns of recurrence and long-term survival outcomes. This study aims to explore those patterns of recurrence following sLND in patients with oligorecurrent disease. Additionally, we investigate factors associated with disease progression after sLND.

METHODS

Utilizing the prospectively maintained C11 choline positron emission tomography (PET)/computed tomography (CT) scan registry, we identified patients who underwent salvage lymph node dissection for oligorecurrent disease detected by C11 choline PET/CT. Primary objective was to characterize the patterns of recurrence after sLND. Recurrence sites following the procedure were classified into 3 categories: local recurrence, locoregional lymph node recurrence, and progression to distant metastatic spread. Secondary objective was to identify factors associated with disease progression to distant metastases. The median follow-up duration was 111 months.

RESULTS

We identified 152 patients who underwent sLND for nodal recurrence prostate cancer. At time of sLND, the median (interquartile range [IQR]) age was 65 years (59.4-70.6), median (IQR) prostate-specific antigen of 2.1 ng/dl (1.3-3.9), and 27% of patients had castration-resistant prostate cancer. The median (IQR) number of lymph nodes dissected was 18 (12-27), while the median (IQR) number of positive lymph nodes was 3 (1-5). The anatomical distribution of sites of recurrence after sLND demonstrated approximately 6.4% of local recurrence in the prostate bed, 34.5% of loco-regional nodal recurrent, and 59% metastatic disease. In univariable and multivariable analyses of factors associated with disease progression to metastatic disease, only the number of positive lymph nodes at sLND was associated with increased risk of progression to distant metastatic disease with 14% increased risk for each positive lymph node.

CONCLUSIONS

The role of sLND in patients with oligorecurrent disease remains investigational. Recurrence is anatomically diverse, including progression to distant metastatic disease. The number of positive nodes at sLND serves as a useful predictor of progression and can help guide decisions on adjuvant therapies, supporting a more personalized postoperative approach.