Category: Laparoscopic/ Robotic: Prostate
Introduction & Objective : we are presenting our early experience with targeted salvage lymph nodes dissection in 2 patients who had lymph node-only recurrence based on fluciclovine F 18 (Axumin) PET scan.
Methods : Fluciclovine F 18 (Axumin) PET scan was recently approved by the FDA for detection of cancer recurrence in patients with rising PSA following primary therapy for prostate cancer. We are reporting our only experience with salvage pelvic lymph nodes dissection (PLND) in 2 patients who had lymph node-only recurrence based on fluciclovine F 18 (Axumin) PET scan. Patient 1 is 63 y.o African American who was treated with brachytherapy 9 years prior to presentation (PTP). In 2014, His PSA rose gradually from 0.2 ng/ml to 6.37 ng/ml in 2018. Axumin PET scan showed intense intake in 2.4 x 1.3 cm right external iliac lymph node. Patient 2 is a 70 y.o Hispanic male who underwent robotic radical prostatectomy and PLND 6 years PTP. PSA went down to undetectable then started to rise 2 years after surgery. Patient had negative MRI and NaF PET scan and underwent salvage radiation therapy (X-RT). PSA kept on rising despite X-RT. Repeat NaF PET scan was negative for metastasis. However, Axumin PET scan showed intense intake in a 0.7 cm right internal iliac lymph node. Patient 2 underwent targeted LND of the right internal iliac artery lymph nodes.
Results : Patient 1 had uneventful bilateral pelvic lymph nodes dissection. Total surgery time was 1 hour ( Console time 50 minutes). A total of 15 lymph nodes were removed. Pathology showed metastasis to a single lymph node that correlated with the PET scan finding. PSA went down from 6.37 ng/ml to 0.02 ng/ml 6 months after surgery. Patient 2 had targeted right internal iliac lymph nodes dissection. Total surgery time was 35 minutes (Console time 30 minutes). Final pathology showed involvement of one (0.7cm) lymph node out of seven removed. PSA was undetectable 3 weeks after surgery
Conclusions : Our early experience with salvage PLND based on Axumin PET scan is promising. This manuscript represents the first reported experience in the literature.
Professor of Urology
Medical College of Georgia at Augusta University Health