10th SEEM: Rationale for salvage LND in prostate cancer

Salvage lymph node dissection in locally advanced prostate cancer is a viable option but requires careful patient selection and the use of suitable imaging techniques, according to Prof. Bob Djavan (AT) during the EAU lecture he presented at the first day of the 10th South Eastern European Meeting (SEEM) in Belgrade, Serbia.

“Salvage lymph node dissection might be considered an intriguing option which is still under investigation, and only if a correct patient selection is made. Patient selection remains key,” said Djavan.

Around 500 participants gathered in Belgrade for the 10th SEEM, the third time Serbia is hosting the annual event organised by the Regional Office.

In his keynote lecture, Djavan focused on patients with locally advanced prostate cancer who have recurrent disease in their lymph nodes despite previous medical or surgical interventions. With the southeastern European region having one of the highest incidence of recurrent prostate disease, Djavan said that it is crucial for urologists to consider the option of a secondary lymph node dissection.

There are caveats or careful requirements before taking this option, according to Djavan as he underscored the need for urologists to use the appropriate imaging technique such as choline PET scan. He also noted that standard MRI will not be helpful, considering its lower sensitivity and accuracy rates.

Another consideration is determining if the patient belongs to the right selection group. “Patients with secondary biochemical recurrence is highly heterogeneous, it is therefore crucial to satisfy the requirement of care patient selection,” he added.

The following are his key messages:

• The rationale for salvage LND might reside in the nodal mestastatizing spread of PCa which still need to be elucidated ;

• The prerequisite for any non-systemic salvage approach is the availability of accurate and sensitive imaging modality for detecting nodal recurrence;

• There are few studie, including approximately 200 patients are available in the literature, and all of them are limited by heterogeneous patient population and limited follow-up