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24 July 2008
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Pelvic node dissection outcome good in patients with minimal node involvement
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MedWire News: Prostate cancer patients with no more than two positive nodes have good outcomes after extended pelvic lymph node dissection (PLND) followed by radical retropubic prostatectomy (RRP), and should not be denied curative treatment, say Swiss scientists.
The evidence supporting the use of extended PLND in node-positive patients undergoing RRP for clinically localized prostate cancer is conflicting, explains Urs Studer and colleagues from the University of Bern.
To investigate further, the team therefore studied 122 node-positive patients with negative pre-operative staging examinations and no neoadjuvant hormonal treatment or radiotherapy who underwent extended PLND followed by RRP.
Extended PLND was defined as at least 10 lymph nodes in the surgical specimen, and the researchers determined biochemical recurrence-free survival, cancer-specific, and overall survival, they note in the journal European Urology.
The median age of the patients at surgery was 64 years, the median pre-operative prostate-specific antigen (PSA) level was 16 ng/ml, and median of 22 nodes were removed per patient. Of the patients, 76% had pT3-pT4 tumors at pathologic examination, while 50% had seminal vesicle infiltration.
The results indicate that 39% of patients had one positive node, 22% had two positive nodes, and 39% had at least three positive nodes. The patients were followed-up for a median of 67 months.
Overall median cancer-specific survival at 5 years and 10 years was 84.5% and 60.1%, respectively. For patients with no more than two nodes removed, median cancer-specific survival at 10 years was 78.6%, compared with 33.4% for patients with at least three positive nodes. Significant predictors of a negative outcome were the total number of positive nodes, at least three positive nodes, tumor stage pT4, and pathologic Gleason score of at least 7, at hazard ratios of 1.38, 5.64, 4.05, and 2.42, respectively.
Androgen deprivation therapy was administered to 50% of patients after a median of 33 months, with 69% of those with at least three positive nodes removed treated, compared with 41% of those with two positive nodes.
The team concludes: "Good long-term survival was found after extended PLND followed by RRP in patients with only minimal lymph node involvement."
Eur Urol 2008; 54: 344-352
http://dx.doi.org/10.1016/j.eururo.2008.05.023
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