Influence of pelvic lymph node dissection and node‐positive disease on biochemical recurrence, secondary treatment, and survival after radical prostatectomy in men with prostate cancer. Issue 2 (19th October 2020)

• Record Type: Journal Article
• Authors: Washington, Samuel L.; Cowan, Janet E.; Herlemann, Annika; Zuniga, Kyle B.; Masic, Selma; Nguyen, Hao G.; Carroll, Peter R.
• Is Part Of: Prostate. Volume 81:Issue 2(2021)
• Page Start: 102
• Page End: 108
• Publication Date: 2020-10-19
• Subjects: prostate cancer -- node positive -- radical prostatectomy -- lymph node dissection; Prostate -- Diseases -- Periodicals; 616
• DOI: 10.1002/pros.24085
• Languages: English
• ISSNs: 0270-4137

Abstract

Abstract: Background: The benefit of pelvic lymph node dissection (PLND) at radical prostatectomy (RP) remains unclear given the low prevalence of known nodal disease (pN1) and concerns about its therapeutic utility. Objective: To characterize the impact of PLND and secondary treatment on oncologic outcomes. Design, Setting, and Participants: Cohort study of men who underwent primary RP with PLND for prostate cancer (PCa) at our institution since 2003. Men stratified by nodal status. Outcome Measures and Statistical Analysis: Outcomes include biochemical recurrence‐free survival (bRFS), overall survival, and PCa‐specific mortality (PCSM). Multivariable Cox regression models used for each outcome. Results and Limitations: Of 1, 543 men who underwent primary RP, 174 (11%) had pN1 disease. Median follow‐up was 34 months (interquartile range, 15–62). Seven‐year outcomes were similar whether less than or ≥14 LNs dissected. Among node‐positive patients, 29% had undetectable (UDT) prostate‐specific antigen (PSA), 11% had UDT PSA + adjuvant therapy, and 60% had detectable PSA, and 7‐year bRFS differed (75% for UDT PSA, 90% for UDT + adjuvant therapy, 38% for detectable PSA, p < .01). Survival outcomes did not differ. In multivariable analysis, detectable PSA (vs. UDT, HR 5.2, 95% CI 2.0–13.3) associated with worse bRFS. After salvage treatment, 7‐year outcomes did not differ between groups. Study limited by retrospective review.