Is there a role for a salvage lymph node dissection in patients who present with a biochemical failure after prostatectomy?

It's an important question without randomized data to support an answer. Even this question will evolve as we bring on-board more advanced imaging such as Fluciclovine PET/CT, PSMA PET, etc. These scans are continuuing to introduce new challenges as we start to resolve the location of lesions and so-far we are in the realm of anecdote. It is hard to justify any rationale for Pelvic LND in clinically node negative patient with biochemical failure only, as a surgeon could not possibly dissect all the lymph node stations at risk for occult disease. In a patient with imaging evidence of nodal persistence recurrence, we only have anecdotes. Case in point: we have a patient wo had a PSA of about 3.0 after prostatectomy who received a fluciclovine...

There is a prospective randomized trial headed by the NRG looking at the impact of pelvic nodal RT in this setting but there is no randomized data looking at pelvic LND in this setting so at this time the use of pelvic LND should be considered investigational and not proven to provide clinical benefit.