[First results of PET / CT-guided secondary lymph node surgery on patients with a PSA relapse after radical prostatectomy]

Alexander Winter, J Uphoff, R-P Henke, F Wawroschek
Aktuelle Urologie 2009, 40 (5): 294-9

PURPOSE: CT and MRT are not applicable for the early detection of lymph node (LN) recurrence in prostate cancer. The PET / CT ((11)C-, (18)F-choline) technique can detect lesions >or= 5 mm and allows their topographic localisation. We have analysed positive (11)C-choline PET / CT LN findings in the case of a PSA increase after radical prostatectomy (RPE) histologicaly and documented the developing of PSA.

MATERIALS AND METHODS: 8 patients with PSA relapse after RPE and lymphadenedtomy (LA) were diagnosed as having LNM by means of (11)C-choline PET / CT. Using PET / CT, metastasis suspicious and nearby LN were openly dissected. Histological and PET / CT results were compared and the postoperative PSA-development was examined.

RESULTS: Of the metastasis suspicious LN (11) 9 were histologically reconfirmed. All additionally removed LN (12) were correct negative. LNM were mostly (7 of 9) located in the iliaca interna area and pararectal. 6 of 7 patients with histological metastasis detection showed a PSA response. 3 of 6 patients with single metastasis had complete PSA remission (< 0.01 ng / ml, maximum follow-up: 28 months) without adjuvant therapy.

CONCLUSIONS: (11)C-choline PET / CT could detect LNM with high specificity in our collective. These often lie beyond standard LA area, where they were primarily only resected by use of extended or sentinel LA. Because 3 patients with single LNM reached a complete PSA remission (< 0.01 ng / ml) without adjuvant therapy, the selected collective seems to benefit from secondary LN surgery. Whether or not individual patients can be cured by this surgery has to be demonstrated in a longitudinal study. However, an optimal imaging and experience in LN surgery have to be assured.

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