Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Urology
Published in: BMC Urology 1/2015

Open Access 01-12-2015 | Research article

Targeted salvage lymphadenectomy in patients treated with radical prostatectomy with biochemical recurrence: complete biochemical response without adjuvant therapy in patients with low volume lymph node recurrence over a long-term follow-up

Authors: Alexander Winter, Rolf-Peter Henke, Friedhelm Wawroschek

Published in: BMC Urology | Issue 1/2015

Login to get access

Abstract

Background

Choline positron emission tomography/computed tomography (PET/CT) represents an option in restaging of prostate cancer patients with disease relapse after local treatment. The present study assess whether salvage resection of lymph node metastases detected on choline PET/CT imaging in prostate cancer patients with biochemical recurrence after radical prostatectomy can result in a long-term complete biochemical remission, without adjuvant therapy.

Methods

We analysed 13 patients with prostate specific antigen (PSA) recurrence (PSA median 1.64 ng/ml, range 0.5-9.55) after radical prostatectomy and suspicious lymph nodes (median 1; range 1–3) detected on [11C]choline and [18F]fluoroethylcholine PET/CT scans. An open salvage lymphadenectomy of positive lymph nodes in a PET/CT scan and nearby lymph nodes was carried out. We examined PSA outcome without adjuvant therapy; defined complete biochemical remission as PSA <0.01 ng/ml. Histological and PET/CT findings were compared.

Results

Ten of 11 patients with histologically confirmed lymph node metastases showed a PSA response. Three of ten patients with single lymph node metastases had a complete biochemical remission (median follow-up 72 months, range 31.0-83). In five cases with single lymph node metastasis PSA decreased <0.02 ng/ml. Histologically confirmed 13 of 16 metastasis suspicious lymph nodes. No lymph node metastases were detected in two patients. All of the additionally removed 30 lymph nodes were correctly negative.

Conclusions

This is the first confirmation of a complete biochemical remission after PET/CT guided secondary resection of a single lymph node metastasis in prostate cancer patients with biochemical recurrence after radical prostatectomy, over the long-term (>6.5 years), without adjuvant therapy. In order to improve these promising results, longer-term studies with more patients are required.
Literature
1.
Scattoni V, Picchio M, Suardi N, Messa C, Freschi M, Roscigno M, et al. Detection of LN metastases with integrated [11C]choline PET/CT in patients with PSA failure after radical retropubic prostatectomy: Results confirmed by open pelvic retroperitoneal lymphadenectomy. Eur Urol. 2007;52:423–9.CrossRefPubMed
2.
Rigatti P, Suardi N, Briganti A, Da Pozzo LF, Tutolo M, Villa L, et al. Pelvic/retroperitoneal salvage LN dissection for patients treated with radical prostatectomy with biochemical recurrence and nodal recurrence detected by [11C]choline positron emission tomography/computed tomography. Eur Urol. 2011;60:935–43.CrossRefPubMed
3.
Winter A, Uphoff J, Henke RP, Wawroschek F. First results of [11C]choline PET/CT-guided secondary LN surgery in patients with PSA failure and single LN recurrence after radical retropubic prostatectomy. Urol Int. 2010;84:418–23.CrossRefPubMed
4.
Abdollah F, Briganti A, Montorsi F, Stenzl A, Stief C, Tombal B, et al. Contemporary role of salvage lymphadenectomy in patients with recurrence following radical prostatectomy. Eur Urol. 2014, doi:10.1016/j.eururo.2014.03.019, epub ahead of print.
5.
Osmonov DK, Heimann D, Janßen I, Aksenov A, Kalz A, Juenemann KP. Sensitivity and specificity of PET/CT regarding the detection of lymph node metastases in prostate cancer recurrence. Springerplus. 2014;3:340. doi:10.1186/2193-1801-3-340.CrossRefPubMedPubMedCentral
6.
Umbehr MH, Müntener M, Hany T, Sulser T, Bachmann LM. The role of 11C-choline and 18 F-fluorocholine positron emission tomography (PET) and PET/CT in prostate cancer: a systematic review and meta-analysis. Eur Urol. 2013;64:106–17.CrossRefPubMed
7.
Birkhäuser FD, Studer UE, Froehlich JM, Triantafyllou M, Bains LJ, Petralia G, et al. Combined ultrasmall superparamagnetic particles of iron oxide-enhanced and diffusion-weighted magnetic resonance imaging facilitates detection of metastases in normal-sized pelvic LNs of patients with bladder and prostate cancer. Eur Urol. 2013;64:953–60.CrossRefPubMed
8.
Withrow DR, DeGroot JM, Siemens DR, Groome PA. Therapeutic value of LN dissection at radical prostatectomy: a population-based case-cohort study. BJU Int. 2011;08:209–16.CrossRef
9.
Von Bodman C, Godoy G, Chade DC, Cronin A, Tafe LJ, Fine SW, et al. Predicting biochemical recurrence-free survival for patients with positive pelvic LNs at radical prostatectomy. J Urol. 2010;184:143–8.CrossRef
10.
Jilg CA, Rischke HC, Reske SN, Henne K, Grosu AL, Weber W, et al. Salvage LN dissection with adjuvant radiotherapy for nodal recurrence of prostate cancer. J Urol. 2012;188:2190–7.CrossRefPubMed
11.
Rinnab L, Mottaghy FM, Blumstein NM, Reske SN, Hautmann RE, Hohl K, et al. Evaluation of [11C]-choline positron emission/computed tomography in patients with increasing prostate-specific antigen levels after primary treatment for prostate cancer. BJU Int. 2007;100:786–93.CrossRefPubMed
12.
Meijer HJ, Debats OA, Kunze-Busch M, van Kollenburg P, Leer JW, Witjes JA, et al. Magnetic resonance lymphography-guided selective high-dose lymph node irradiation in prostate cancer. Int J Radiat Oncol Biol Phys. 2012;82:175–83.CrossRefPubMed
13.
Martini T, Mayr R, Trenti E, Palermo S, Comploj E, Pycha A, et al. The role of C-choline PET/CT guided secondary lymphadenectomy in patients with PSA failure after radical prostatectomy: Lessons Learned from Eight Cases. Adv Uro 2012; doi:10.1155/2012/601572.
14.
Daneshmand S, Quek ML, Stein JP, Lieskovsky G, Cai J, Pinski J, et al. Prognosis of patients with lymph node positive prostate cancer following radical prostatectomy: long-term results. J Urol. 2004;172:2252–5.CrossRefPubMed
15.
Briganti A, Karnes JR, Da Pozzo LF, Cozzarini C, Gallina A, Suardi N, et al. Two positive nodes represent a significant cut-off value for cancer specific survival in patients with node positive prostate cancer. A new proposal based on a two-institution experience on 703 consecutive N+ patients treated with radical prostatectomy, extended pelvic LN dissection and adjuvant therapy. Eur Urol. 2009;55:261–70.CrossRefPubMed
16.
Touijer KA, Mazzola CR, Sjoberg DD, Scardino PT, Eastham JA. Long-term Outcomes of patients with lymph node metastasis treated with radical prostatectomy without adjuvant androgen-deprivation therapy. Eur Urol. 2014;65:20–5.CrossRefPubMed
17.
Hara T, Kosaka N, Kishi H. Pet imaging of prostate cancer using carbon-11-choline. J Nucl Med. 1998;39:990–5.PubMed
18.
Husarik DB, Miralbell R, Dubs M, John H, Giger OT, Gelet A, et al. Evaluation of [(18)f]-choline PET/CT for staging and restaging of prostate cancer. Eur J Nucl Med Mol Imaging. 2008;35:253–63.CrossRefPubMed
19.
Hövels AM, Heesakkers RA, Adang EM, Jager GJ, Strum S, Hoogeveen YL, et al. The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: A meta-analysis. Clin Radiol. 2008;63:387–95.CrossRefPubMed
20.
Beer AJ, Eiber M, Souvatzoglou M, Holzapfel K, Ganter C, Weirich G, et al. Restricted water diffusibility as measured by diffusion-weighted MR imaging and choline uptake in (11)C-choline PET/CT are correlated in pelvic lymph nodes in patients with prostate cancer. Mol Imaging Biol. 2011;13:352–61.CrossRefPubMed
21.
Picchio M, Briganti A, Fanti S, Heidenreich A, Krause BJ, Messa C, et al. The role of choline positron emission tomography/computed tomography in the management of patients with prostate-specific antigen progression after radical treatment of prostate cancer. Eur Urol. 2011;59:51–60.CrossRefPubMed
22.
Vees H, Buchegger F, Albrecht S, Khan H, Husarik D, Zaidi H, et al. 18 F-choline and/or 11C-acetate positron emission tomography: detection of residual or progressive subclinical disease at very low prostate-specific antigen values (<1 ng/ml) after radical prostatectomy. BJU Int. 2007;99:1415–20.CrossRefPubMed
23.
Castellucci P, Fuccio C, Rubello D, Schiavina R, Santi I, Nanni C, et al. Is there a role for 11C-choline PET/CT in the early detection of metastatic disease in surgically treated prostate cancer patients with a mild PSA increase <1.5 ng/ml? Eur J Nucl Med Mol Imaging. 2011;38:55–63.CrossRefPubMed
24.
Mamede M, Ceci F, Castellucci P, Schiavina R, Fuccio C, Nanni C, et al. The role of 11C-choline PET imaging in the early detection of recurrence in surgically treated prostate cancer patients with very low PSA level <0.5 ng/ml. Clin Nucl Med. 2013;38:342–5.CrossRef
25.
Giovacchini G, Picchio M, Scattoni V, Garcia Parra R, Briganti A, Gianolli L, et al. PSA doubling time for prediction of [(11)C]choline PET/CT findings in prostate cancer patients with biochemical failure after radical prostatectomy. Eur J Nucl Med Mol Imaging. 2010;37:1106–16.CrossRefPubMed
26.
Fuccio C, Schiavina R, Castellucci P, Rubello D, Martorana G, Celli M, et al. Androgen deprivation therapy influences the uptake of 11C-choline in patients with recurrent prostate cancer: the preliminary results of a sequential PET/CT study. Eur J Nucl Med Mol Imaging. 2011;38:1985–9.CrossRefPubMed
27.
Afshar-Oromieh A, Zechmann CM, Malcher A, Eder M, Eisenhut M, Linhart HG, et al. Comparison of PET imaging with a 68Ga-labelled PSMA ligand and 18 F-choline-based PET/CT for the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2014;41:11–20.CrossRefPubMed
28.
Passoni NM, Suardi N, Abdollah F, Picchio M, Giovacchini G, Messa C, et al. Utility of [11C]choline PET/CT in guiding lesion-targeted salvage therapies in patients with prostate cancer recurrence localised to a single lymph node at imaging: Results from a pathologically validated series. Urol Oncol. 2014;32:38. e9-38.e16.PubMed
Metadata
Title
Targeted salvage lymphadenectomy in patients treated with radical prostatectomy with biochemical recurrence: complete biochemical response without adjuvant therapy in patients with low volume lymph node recurrence over a long-term follow-up
Authors
Alexander Winter
Rolf-Peter Henke
Friedhelm Wawroschek
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Urology / Issue 1/2015
Electronic ISSN: 1471-2490
DOI
https://doi.org/10.1186/s12894-015-0004-y

Other articles of this Issue 1/2015

BMC Urology 1/2015 Go to the issue

Research article

Urinary ATP as an indicator of infection and inflammation of the urinary tract in patients with lower urinary tract symptoms

Research article

High acceptability of a newly developed urological practical skills training program

Research article

Effects of tadalafil treatment after bilateral nerve-sparing radical prostatectomy: quality of life, psychosocial outcomes, and treatment satisfaction results from a randomized, placebo-controlled phase IV study

Technical advance

A comparison of supracostal and infracostal access approaches in treating renal and upper ureteral stones using MPCNL with the aid of a patented system

Research article

Tadalafil 5 mg once daily for the treatment of erectile dysfunction during a 6-month observational study (EDATE): impact of patient characteristics and comorbidities

Research article

Preclinical assessment of potential interactions between botulinum toxin and neuromodulation for bladder micturition reflex