An Explanatory Case on the Limitations of Lymph Node Staging in Recurrent Prostate Cancer

We describe the case of a 54-year-old man with nodal recurrence prostate cancer after radical prostatectomy, salvage external-beam radiotherapy and salvage lymph node dissection. The patient was evaluated with a lymphotropic ultrasmall superparamagnetic particles of iron oxide (USPIO)-MRI and a 68Ga radiolabelled prostate specific membrane antigen (Ga68-PSMA) PET-CT scan which enhanced persistent localized nodal disease. The patient was then considered for a second robot-assisted extended S-LND. Differently from preoperative imaging, pathology report revealed a wide nodal involvement mirroring a metastatic disease. The current manuscript is an explanatory case on the limitations of lymph node imaging in prostate cancer recurrence.