BACKGROUND: Lymph node invasion (LNI) represents a poor prognostic factor after primary radical prostatectomy (RP) for prostate cancer (PCa). However, the impact of LNI on oncologic outcomes in salvage radical prostatectomy (SRP) patients is unknown. OBJECTIVE: To investigate the impact of lymph node dissection (LND) and pathological lymph node status (pNX vs. pN0 vs. pN1) on long-term oncologic outcomes of SRP patients. PATIENTS AND METHODS: Patients who underwent SRP for recurrent PCa between 2000 and 2021 were identified from 12 high-volume centers. Kaplan-Meier analyses and multivariable Cox regression models were used. Endpoints were biochemical recurrence (BCR), overall survival (OS), and cancer-specific survival (CSS). RESULTS: Of 853 SRP patients, 87% (n = 727) underwent LND, and 21% (n = 151) harbored LNI. The median follow-up was 27 months. The mean number of removed lymph nodes was 13 in the LND cohort. At 72 months after SRP, BCR-free survival was 54% vs. 47% vs. 7.2% for patients with pNX vs. pN0 vs. pN1 (p < 0.001), respectively. At 120 months after SRP, OS rates were 89% vs. 81% vs. 41% (p < 0.001), and CSS rates were 94% vs. 96% vs. 82% (p = 0.02) for patients with pNX vs. pN0 vs. pN1, respectively. In multivariable Cox regression analyses, pN1 status was independently associated with BCR (HR: 1.77, p < 0.001) and death (HR: 2.89, p < 0.001). CONCLUSIONS: In SRP patients, LNI represents an independent poor prognostic factor. However, the oncologic benefit of LND in SRP remains debatable. These findings underline the need for a cautious LND indication in SRP patients as well as strict postoperative monitoring of SRP patients with LNI.

Department of Surgical Sciences San Giovanni Battista Hospital University of Turin 10124 Turin Italy

Department of Urologic Surgery Vanderbilt University Medical Center Nashville TN 37232 USA

Department of Urology 2nd Faculty of Medicine Charles University 116 36 Prague Czech Republic

Department of Urology Institut Mutualiste Montsouris Université Paris Descartes 75270 Paris France

Department of Urology Koc University Hospital 34010 Istanbul Turkey

Department of Urology Ludwig Maximilians University of Munich 80539 Munich Germany

Department of Urology Mayo Clinic Rochester MN 55902 USA

Department of Urology Medical University of Silesia 40 055 Zabrze Poland

Department of Urology Medical University of Vienna 1090 Vienna Austria

Department of Urology Netherlands Cancer Institute 1066 Amsterdam The Netherlands

Department of Urology University Hospital Hamburg Eppendorf 20251 Hamburg Germany

Department of Urology University Hospitals Leuven 3000 Leuven Belgium

Department of Urology University of Texas Southwestern Dallas TX 75390 USA

Department of Urology Weill Cornell Medical College New York NY 10075 USA

Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman 19628 Jordan

Keck Medical Center of USC USC Institute of Urology University of Southern California Los Angeles CA 90033 USA

Martini Klinik Prostate Cancer Center University Hospital Hamburg Eppendorf 20251 Hamburg Germany

Urology Centre Guy's Hospital London SE1 9RT UK

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