Long Term Outcome After Radical Prostatectomy For Patients With Lymph Node Positive Prostate Cancer In The Prostate Specific Antigen Era

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health
Article Date: 26 Aug 2007 - 0:00 PDT

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UroToday.com- In the July 2007 early view of the Journal of Urology, Dr. Boorjian and associates from the Mayo Clinic report that patients with prostate cancer (CaP) metastatic to lymph nodes that also had radical prostatectomy (RP) experience 85.8%, 10-year cancer specific survival.

A total of 507 men who underwent RP between 1988 and 2001 were identified as having pathologically confirmed CaP metastatic to lymph nodes. Postoperative followup data was recorded and a biochemical recurrence was defined as a PSA >0.4ng/ml or greater. Cause of death was obtained from death certificates or physician records.

The incidence of men with positive lymph nodes decreased over the 13 year study period. Patients with positive lymph nodes had higher preoperative PSA levels, were more likely to have non organ confined CaP, and had a greater number of lymph nodes surgically excised. Of the 199 men that had preoperative imaging by CT or MRI only 2 had positive lymph nodes identified. After surgery, 455 of the 507 men (89.7%) received adjuvant hormonal therapy. Additionally, 44 men (8.7%) had adjuvant radiotherapy and 39 (7.7%) received salvage radiotherapy.

At a median follow-up of 10.3 years 213 men had a biochemical recurrence, 51 had a local recurrence, 97 a metastatic recurrence, and 200 patients had died of which the cause was CaP in 72. The 10-year event-free survival for the study cohort was 56%, 89%, 80%, and 86% for biochemical recurrence, local recurrence, systemic progression, and CaP death. While a single metastatic node significantly increased the risk of PSA recurrence increasing nodal involvement did not worsen the risk. Patients with 2 or more positive lymph nodes were twice as likely to experience systemic progression as patients with 1 positive lymph node. In multivariate analysis, increased preoperative PSA, and non-diploid tumor ploidy were predictors of biochemical recurrence. The risk for systemic progression increased with 2 or more involved lymph nodes, Gleason 8-10 tumors, or a positive surgical margin. The risk of CaP death was predicted for by Gleason score 8-10, lymph node burden, non-diploid tumors, and positive surgical margins. Use of adjuvant hormonal deprivation was associated with a decreased risk of PSA recurrence and local recurrence but it did not impact systemic progression or cancer specific survival.

Boorjian SA, Thompson RH, Siddiqui S, Bagniewski S, Bergstralh EJ, Karnes RJ, Frank I, Blute ML

J Urol. ePub: July 16, 2007
DOI: 10.1016/j.juro.2007.05.048

Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D

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