The role of salvage lymph node dissection in nonmetastatic castration-resistant prostate cancer: A single center experience

Objective: To evaluate oncologic outcomes of patients with nonmetastatic, castration-resistant prostate cancer treated with salvage lymph node dissection (sLND) or androgen-deprivation therapy (ADT) for lymph nodes (LN)-only recurrence. Materials and Methods: Retrospective analysis of 23 (51.1%) patients who underwent sLND and 22 (48.9%) men who received ADT for LN-only recurrence. Biochemical recurrence (BCR) was defined as prostate-specific antigen (PSA) >0.2 ng/ml with an increased trend and radiological recurrence (RAR) was defined as a positive imaging study after sLND or ADT. Second line systemic therapies (SST) were defined as any systemic therapy administered for progression. Predictors of BCR, RAR, and SST were assessed with Cox regression analyses. Results: Mean PSA reduction was significantly higher after sLND than ADT (62.8% vs. 17.7%; P = 0.04). Clinical outcomes were not statistically different between the 2 groups. However, there was a trend toward a longer time to BCR (13.3 vs. 6 months; P = 0.2) and RAR (21.1 vs. 14.2 months, P = 0.09) in sLND patients than ADT. Median time to SST was longer in the sLND group than ADT (P = 0.04). Univariable Cox regression analyses showed that PSA doubling time and pT stage were associated with RAR and SST (all P < 0.05). Conclusions: In patients with nonmetastatic, castration-resistant prostate cancer, sLND resulted in greater PSA decrease than ADT. We noted a nonstatistically significant trend toward longer time to BCR and longer time to RAR for patients treated with sLND than ADT. Additionally, sLND may increase time to SST as compared to ADT.