Introduction: Several studies have reported a very low incidence of lymph node metastasis in D’Amico low-risk prostate cancer. As a result, omission of the pelvic lymphadenectomy (PLND) has become more common in this group. We evaluated whether omission of a PLND in these patients was associated with increased rates of 5-year biochemical recurrence (BCR).
Materials and Methods: The study population included 535 patients with prostate cancer clinical stage T1-2, Gleason 3 + 3, and PSA < 10 ng/mL. Patients were divided into 2 groups, those with a limited PLND (+PLND) at the time of prostatectomy (N = 139) and those without (–PLND) (N = 396). BCR was defined as PSA > 0.2 ng/mL at any time following surgery. Univariate and multivariate Cox proportional hazards analyses were applied to evaluate the association between the omission of PLND and BCR.
Results: Median follow-up was 43 months (range 0.4 to 194.8). The mean number of lymph nodes obtained at PLND was 6.2 (range 1 – 38). Of these, 122 men had BCR during follow-up. Men who had PLND had earlier surgery dates and were more likely to have had open prostatectomy. They were also associated with higher preop PSAs, fewer biopsy cores but a higher percent of positive cores, and higher maximum cancer in any 1 core. Kaplan-Meier analysis revealed similar survival curves for both groups (log-rank test P = 0.723). Using the univariate Cox proportional hazards analysis, omission of PLND was not associated with a higher risk of BCR when compared to +PLND. Preoperative PSA, year of surgery, procedure type, pathologic Gleason score and stage, as well as margin status were all significantly (P < 0.05) associated with the risk of BCR, while African American race approached significance (P = 0.062).
Conclusion: With a 43-month median follow-up, D’Amico low-risk prostate cancers are no more likely to develop BCR when limited PLND is omitted than those who undergo limited PLND. A potentially confounding variable might be the variability in the extent of PLND.
Joshua E. Logan, Bethany Barone Gibbs, Stephen B. Riggs, Robert W. Given, Michael D. Fabrizio, Paul F. Schellhammer, Raymond S. Lance
Department of Urology, Eastern Virginia Medical School, Norfolk, Virginia
Submitted November 20, 2013 - Accepted for Publication November 28, 2013
KEYWORDS: Prostate cancer, pelvic lymph node dissection, PSA
CITATION: UroToday Int J. 2013 December;6(6):art 73. http://dx.doi.org/10.3834/uij.1944-5784.2013.12.08