The role of salvage lymph node dissection and PSMA-PET in recurrent prostate cancer

摘要

Although up to 50% of the patients undergoing radical prostatectomy (RP) for clinically localized prostate cancer (PCa) are expected to experience biochemical recurrence sometime in their life (1), the introduction of novel techniques like the PSMA PET/CT can improve the diagnosis at the stage of lymph nodes-only recurrence (2-4). As we recently showed, the combination of PSMA PET with extended lymph node dissection has 94% accuracy for nodal staging in primary diagnosed intermediate- and high-risk PCa, while adding sentinel node biopsy in negative PSMA PET/CT increased the combined sensitivity to 100% (5). While the mainstay of treatment for these patients has traditionally been the administration of androgen deprivation therapy (ADT) (6), new approaches such as salvage lymph node dissection (SLND) have started coming to the front aiming to delay palliative ADT or improve survival in carefully selected patients (7,8).