Salvage lymphadenectomy in patients with lymphogenic prostate cancer progression after radical treatment: results of a multicenter study

• Main Authors: B. Ya. Alekseev, K. M. Nyushko, S. A. Reva, A. K. Nosov, D. G. Prokhorov, T. T. Andabekov, A. A. Krasheninnikov, E. Yu. Safronova, M. I. Shkol’nik, S. B. Petrov, A. S. Kalpinskiy, A. D. Kaprin
• Format: Article
• Language: Russian
• Published: ABV-press 2016-12-01
• Series: Onkourologiâ
• Subjects: prostate cancer; oligometastases; lymphogenic progression; salvage lymphadenectomy; short-term treatment results; long-term treatment results; multicenter study
• Online Access: https://oncourology.abvpress.ru/oncur/article/view/594
• ISSN: 1726-9776; 1996-1812

Prostate cancer (PC) is one of the most challenging and pressing problems of modern oncourology because of high morbidity associated with the disease. The main methods of radical treatment of patients with localized and regional PC are radical prostatectomy and beam radiation therapy, external or brachytherapy. Nonetheless, the rate of biochemical progression of the disease after radical treatment remains high and averages 27–53 %. Of the utmost importance is determination of the tumor nidus which raises the marker level. Currently, in patients with distant metastases the only widely accepted treatment method is palliative hormonal therapy (HT). However, in majority of patients marker recurrence can be associated with so-called oligometastatic progression characterized by a minimal number of detectable metastases. Research shows that surgical treatment or beam radiation therapy in selected patients of this cohort allows to significantly increase the time until HT prescription, and in some cases to abandon it altogether. The article describes the results of surgical treatment of patients subjected to salvage lymphadenectomy for oligometastatic PC progression at three centers: P.A. Hertzen Moscow Oncology Research Institute, N.N. Petrov Research Institute of Oncology and Russian Research Center for Radiology and Surgical Technologies. In the multicenter study, short-term and longterm results of surgical treatment of 57 patients were evaluated. It was shown that in some patients, salvage lymphadenectomy can be an effective treatment option significantly lengthening the time until HT prescription, and in 23.4 % of patients it can lead to long-term (12 months) stabilization of the disease and 90 % decrease in prostate-specific antigen level compared to the initial pre-surgery level without any additional forms of therapy.