Salvage lymphadenectomy after primary therapy with curative intent for prostate cancer

被引:1
作者
Quhal, Fahad [1 ,2 ]
Bryniarski, Piotr [3 ]
Rivas, Juan Gomez [4 ]
Gandaglia, Giorgio [5 ]
Shariat, Shahrokh F. [1 ,6 ,7 ,8 ,9 ,10 ]
Rajwa, Pawel [1 ,3 ]
机构
[1] Med Univ Vienna, Dept Urol, Vienna, Austria
[2] King Fahad Specialist Hosp, Dept Urol, Dammam, Saudi Arabia
[3] Med Univ Silesia, Dept Urol, Zabrze, Poland
[4] Hosp Clin San Carlos, Dept Urol, Madrid, Spain
[5] IRCCS Osped San Raffaele, Urol Res Inst, Unit Oncol, Unit Urol, Milan, Italy
[6] Weill Cornell Med Coll, Dept Urol, New York, NY USA
[7] Charles Univ Prague, Fac Med 2, Dept Urol, Prague, Czech Republic
[8] Univ Texas Southwestern, Dept Urol, Dallas, TX USA
[9] Univ Jordan, Dept Special Surg, Div Urol, Amman, Jordan
[10] Karl Landsteiner Inst Urol & Androl, Vienna, Austria
关键词
biochemical recurrence; lymph node dissection; metastasis-directed therapy; oligometastasis; LYMPH-NODE DISSECTION; RADIOLABELED CHOLINE PET/CT; RADICAL PROSTATECTOMY; RECURRENCE; OUTCOMES; ANTIGEN; TOMOGRAPHY;
D O I
10.1097/MOU.0000000000001103
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose of reviewTo provide a summary of the current literature on salvage lymph node dissection (sLND) in patients with nodal recurrent prostate cancer (PCa) with focus on imaging, the extent of sLND and oncologic outcomes.Recent findingsThe clinical practice guidelines recommend performing PET/CT in patients with biochemical recurrence (BCR) after primary therapy. PSMA PET/CT has demonstrated superiority over choline PET/CT and MRI, especially at low prostate-specific antigen (PSA) levels. Although the heterogeneity in available literature does not allow standardization of surgical templates for sLND and PET/CT scan can guide the extent of surgical dissection, an anatomically defined extended template is typically considered. Radio-guided surgery (RGS) suggests an improved positive lymph node yield compared with standard sLND. However, long-term data are needed to evaluate the oncologic impact of sLND. The main aims of sLND are to delay recurrence and to postpone the need for systemic therapy. Available evidence suggests that around 40-80% of men can achieve complete biochemical response after sLND and 10-30% remain BCR free after 5 years. Robotic sLND might represent an option to reduce the risk of complications without compromising oncological outcomes; validation in controlled prospective studies is, however, needed.sLND is a valid treatment option for patients with nodal recurrence only after primary therapy for PCa. Further optimization of patient selection based on highly sensitive and specific imaging and clinical factors remains an unmet need. To maximize the benefit of this approach, sLND should be discussed with patients who harbor lymph node-only recurrence after primary therapy in a shared decision-making.
引用
收藏
页码:269 / 273
页数:5
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