Safety and efficacy of salvage lymph node dissection in prostate cancer patients with nodal recurrence after radical prostatectomy: A prospective single center phase I/II study.

• DOI: 10.1200/jco.2025.43.5_suppl.149
• Publication Date: 2025-02-18T14:35:11Z
• Authors: Nicolai A Huebner; Bernhard Grubmueller; David D'Andrea; Eva Comperat; Pascal Baltzer; Sazan Rasul; Shahrokh F. Shariat
• Keywords: Salvage therapy; Biochemical recurrence

149 Background: Optimal management of pelvic nodal recurrence prostate cancer after RP detected by PSMA-PET is still unclear, although a significant change in treatment due to early use PET the setting BCR has been shown multiple trials. As can be seen as “in between” state disease before metastatic disease, metastasis directed therapy could improve oncological outcomes long term or at least delay systemic treatment. Salvage Lymph node dissection (sLND) described retrospective trials effective with biochemical response up 60% patients and BCR-free survival 20%. Aim this study was prospectively evaluate safety well sLAE. Methods: In we included 71 RP. Uptake prostatic fossa, previous radiation short-term ADT were allowed. Patients extra-pelvic metastasis, ECOG ≥2 thromboembolic event within last 6 months excluded. received complete bilateral open sLND. The resection margins cranially aortic bifurcation level IMA, laterally genitofemoral nerve, caudally inguinal ligament Cloquet's lymph node, medially urinary bladder, dorsally wall. obturator fossa excised exposure nerve removal presacral nodes down periosteum. primary endpoints measured complication-rate sLAE PSA. Results: median follow-up 40 months. At time surgery PSA 1.20ng/ml (IQR 0.79-2.69) number positive spots on 2 (IQR1-3). Overall, 30% showed remission defined <0.01. Within follow 90% (n=63) experienced progression. from sLND additional treatments (95%CI – 5) 12 9 24) respectively. LNs removed 39 most common site relapse pelvis. Severe postoperative complications rare yet did occur 5 experiencing Clavien 3,4 which one central pulmonary embolism resulted death patient. Conclusions: Progression delayed sLAE, however long-lasting rare. Certain good initial able avoid While mostly safe, severe side-effects occur. Due potential surgery, it should reserved for highly selected cases. Additional evaluating criteria patient selection are important further explore benefit Clinical trial information: NCT02974075 .