Salvage Lymphadenectomy in the Treatment of Nodal Recurrence of Prostate Cancer Detected by Magnetic Resonance Imaging and PET-PSMA CT - Case Report

Abstract

EFR, 63 years Diagnosis of prostate adeno carcinoma Gleason 6 (3+3) by biopsy indicated by elevation of PSA (4.8mg/dl), in 2011. Patient underwent Radical Prostatectomy (RP) by sampling obturator lymphadenectomy, whose histopathological report revealed ACP Gleason 8 (5+3) with free margins (pT2C) and lymph nodes with no malignancy (pN0). The PSA remained null during the three consecutive years, in 2014 PSA raised (3.14mg/dl). In 2016 PSA reached 17mg/dl. His disease was re-staged and 68Ga-PSMA-PET/CT revealed areas with anomalous increase of 68Ga-PSMA expression in periaortic and iliac lymph nodes on the left, suggestive of secondary neoplastic lesions. In august 2016, patient underwent retroperitoneal Salvage Lymphadenectomy. Lymph node enlargement was identified in the left obturator chain, left external iliac, paracaval and periaortic chain. The histopathological report described metastatic bilaterally obturator chain carcinoma, left internal iliac, pre-sacral left and paraaortic. The 30-day postoperative PSA was 2.57. Salvage Lymphadenectomy is a path for treatment in patients with disease relapse limited to the LNM after RP, it is a method that can postpone androgen deprivation therapy and chemotherapy; clinical trials are needed to legitimize surgery in this specific scenario.