Prostate CancerGood Outcome for Patients with Few Lymph Node Metastases After Radical Retropubic Prostatectomy☆
Introduction
Surgical excision and histologic examination of the pelvic lymph nodes provides the most accurate staging information regarding pelvic lymph node status in patients undergoing radical retropubic prostatectomy (RRP) for clinically localized prostate cancer. The role of extended pelvic lymph node dissection (PLND) in relation to survival, however, remains unclear.
Until recently, the presence of lymph node metastasis in patients with prostate cancer was associated with poor prognosis because chances of cure were slim in the setting of positive nodes [1], [2], [3]. Furthermore, it was thought that PLND could be used to justify cancellation of the subsequent prostatectomy if positive nodes were found, sparing the patient the morbidity of an unnecessary radical prostatectomy [4]. There is also growing evidence that extended PLND in patients with prostate cancer may confer a survival benefit not only for node-positive, but also for node-negative patients [5], [6].
We report the long-term survival rates in node-positive patients with clinically localized prostate cancer who underwent extended PLND followed by RRP without immediate androgen deprivation therapy (ADT).
Section snippets
Patients and methods
A total of 122 consecutive patients with positive nodes detected at extended PLND were identified from a series of 602 patients with clinically localized prostate cancer (N0M0) based on negative staging examinations (bone scan, computerized tomography of pelvis, chest x-ray). The 122 patients were treated by open RRP between April 1989 and January 2007. None of the patients had undergone prior therapy for prostate cancer.
Applying a prospective protocol, a standardized extended extraperitoneal
Statistical analysis
Actuarial long-term biochemical recurrence (BCR)-free survival, cancer-specific survival, and overall survival were assessed according to the Kaplan-Meier technique with patients censored at last follow-up or death. Biochemical failure was defined as a PSA value ≥0.2 ng/ml. Group survival rates were compared using the log rank test (Mantel-Cox). A p value of <0.05 was considered statistically significant. The interaction between the number of positive nodes, number of total nodes, pT-stage,
Results
Median age of the 122 node-positive patients was 64 yr (range 44–75 yr). Median preoperative PSA was 16 ng/ml (range 1.9–172 ng/ml) [Table 1]. A median of 22 nodes (range 10–75) were removed per patient. Of these node-positive patients, 47 (39%) had 1 positive node, 27 (22%) had 2 positive nodes, and 48 (39%) had ≥3 positive nodes.
Discussion
We present long-term survival data on patients with lymph node-positive disease treated with extended PLND followed by RRP. In our series, the overall 10–15 yr actuarial survival rates after extended PLND followed by RRP are in line with other recently published results [8], [9], [10], [11]. Detailed lymph node mapping was performed in all patients and a median of 22 nodes were detected in the surgical specimen per patient. Patients with 1 or 2 positive nodes had a significantly better
Conclusion
Our long-term results in 122 node-positive patients with prostate cancer treated with extended PLND followed by RRP show that the total number of metastatic nodes, but also the pathologic Gleason score and advanced stage of the primary tumour, significantly predict disease progression and survival. Good long-term survival was found after extended PLND followed by RRP in patients with only minimal lymph node involvement (≤2 positive nodes). In two-thirds of patients with 1 positive node and in
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