First Results of PET/CT-Guided Secondary Lymph Node Surgery on Patients with a PSA Relapse after Radical Prostatectomy

Purpose: CT and MRT are not applicable for the early detection of lymph node (LN) recurrence in prostate cancer. The PET/CT (C-11-, F-18-choline) technique can detect lesions >= 5mm and allows their topographic localisation. We have analysed positive C-11-choline PET/CT LN findings in the case of a PSA increase after radical prostatectomy (RPE) histologicaly and documented the developing of PSA. Materials and Methods: 8 patients with PSA relapse after RPE and lymphadenedtomy (LA) were diagnosed as having LNM by means of C-11-choline PET/CT. Using PET/CT, metastasis suspicious and nearby LN were openly dissected. Histological and PET/CT results were compared and the postoperative PSA-development was examined. Results: Of the metastasis suspicious LN (11) 9 were histologically reconfirmed. All additionally removed LN (12) were correct negative. LNM were mostly (7 of 9) located in the iliaca interna area and pararectal. 6 of 7 patients with histological metastasis detection showed a PSA response. 3 of 6 patients with single metastasis had complete PSA remission (<0.01 ng/ml, maximum follow-up: 28 months) without adjuvant therapy. Conclusions: C-11-choline PET/CT could detect LNM with high specificity in our collective. These often lie beyond standard LA area, where they were primarily only resected by use of extended or sentinel LA. Because 3 patients with single LNM reached a complete PSA remission (<0.01 ng/ml) without adjuvant therapy, the selected collective seems to benefit from secondary LN surgery. Whether or not individual patients can be cured by this surgery has to be demonstrated in a longitudinal study. However, an optimal imaging and experience in LN surgery have to be assured.