Salvage Pelvic Lymph Node Dissection and Current State of Imaging for Recurrent Prostate Cancer: Does a Standard Exist?
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PROSTATE CANCER (S PRASAD, SECTION EDITOR)
Salvage Pelvic Lymph Node Dissection and Current State of Imaging for Recurrent Prostate Cancer: Does a Standard Exist? Hannah McCloskey 1 & Jesse Jacobs 1
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& Ibardo Zambrano & Theodore Moore & Amir H. Khandani & Marc A. Bjurlin
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Accepted: 15 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review We aim to evaluate the efficacy of salvage lymph node dissection (SLND) for nodal recurrent prostate cancer after primary treatment. We also provide a review of the diagnostic performance of next-generation sequencing (next-generation imaging (NGI)) radiotracers in the salvage setting. Recent Findings Most studies evaluating SLND include a heterogeneous population with a small sample size and are retrospective in design. The 5-year clinical recurrence-free and cancer-specific survival following SLND are 26–52% and 57–89%, respectively, among prospective studies. NGI improves accuracy in detecting nodal recurrence compared to conventional CT, with PMSA PET-CT showing the most promise. However, limited studies exist comparing imaging modalities and performance is variable at low PSA values. Summary SLND is a promising treatment option, but more prospective data are needed to determine the ideal surgical candidate and long-term oncologic outcomes. More studies comparing different NGI are needed to determine the best imaging modality in patients who may be candidates for salvage treatment. Keywords Prostate cancer . Biochemical recurrence . Lymph node dissection . Imaging . MRI . PET-CT . PET-MRI
Introduction Following radical prostatectomy (RP) for localized prostate cancer (PCa), 20–50% of patients will experience biochemical recurrence (BCR) [1, 2]. Approximately 30–40% of patients with BCR will progress to detectable metastatic disease within 5 years [3, 4]. Current guidelines recommend androgen deprivation therapy (ADT) for the treatment of systemic progression, regardless of metastatic pattern [5]. However, patients with few metastases This article is part of the Topical Collection on Prostate Cancer * Marc A. Bjurlin [email protected] 1
Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Department of Radiology, Division of Molecular Imaging and Therapeutics (Mit), University of North Carolina, Chapel Hill, NC, USA
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Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, 170 Manning Drive, Physicians Office Building, Chapel Hill, NC 27599-7235, USA
confined to the pelvic and retroperitoneal lymph nodes (LN) have better outcomes compared to those with more extensive metastases involving viscera and/or bone [6]. Thus, nodal oligometastatic disease appears to be a transitional state between localized and widespread metastatic disease and may respond to metastasis-directed therapy such as salvage lymph node dissection (SLND). Over the past decade, SLND for nodal recurrence has become a more accepted t
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