Patients with lymph node positive (pN+) disease found at the time of radical prostatectomy with pelvic lymphadenectomy for clinically localized prostate cancer (CaP) are at high risk of disease persistence and progression.
Contemporary management trends of pN+ CaP are not well described.
Patients in the Michigan Urologic Surgery Improvement Collaborative (MUSIC) with clinically localized prostate cancer who underwent radical prostatectomy between 2012 and 2023 with cN0/pN+ disease were identified. The primary outcome was to evaluate patient and practice-level factors associated with time to secondary post-RP treatment. Secondary outcomes included practice-level variation in management of pN+ CaP and rates of secondary treatment modality. To assess factors associated with secondary treatment, a Cox proportional hazards model of a 60-day landmark analysis was performed.
We identified 666 patients with pN+ disease. Overall, 66% underwent secondary treatment within 12 months post-RP. About 19% of patients with detectable post-RP PSA did not receive treatment. Of patients receiving secondary treatment after 60-days post-RP, 34% received androgen deprivation therapy (ADT) alone, 27% received radiation (RT) alone, 36% received combination, and 4% received other systemic therapies. In the multivariable model, pathologic grade group (GG)3 (HR 1.5; 95%CI: 1.05-2.14), GG4-5 (HR 1.65; 95%CI: 1.16-2.34), positive margins (HR 1.46; 95%CI: 1.13-1.88), and detectable postoperative PSA ≥0.1 ng/ml (HR 3.46; 95%CI: 2.61-4.59) were significantly associated with secondary post-RP treatment. There was wide variation in adjusted practice-level 12-month secondary treatment utilization (28%-79%).
The majority pN+ patients receive treatment within 12 months post-RP which was associated with high-risk pathological features and post-RP PSA. Variation in management of pN+ disease highlights the uncertainty regarding the optimal management. Understanding which patients will benefit from secondary treatment, and which type, will be critical to minimize variation in care.
Urologic oncology. 2024 Apr 02 [Epub ahead of print]
Daniel Triner, Stephanie Daignault-Newton, Udit Singhal, Michael Sessine, Robert T Dess, Megan E V Caram, Tudor Borza, Kevin B Ginsburg, Brian R Lane, Todd M Morgan, Michigan Urological Surgery Improvement Collaborative
Department of Urology, Michigan Medicine, Ann Arbor, MI. Electronic address: ., Department of Urology, Michigan Medicine, Ann Arbor, MI., Department of Urology, Michigan Medicine, Ann Arbor, MI; Department of Urology, Mayo Clinic, Rochester, MN., Department of Urology, Wayne State University School of Medicine, Detroit, MI., Department of Radiation Oncology, Michigan Medicine, Ann Arbor, MI., Division of Hematology/Oncology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI., Division of Urology, Corewell Health Hospital System, Grand Rapids, MI.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/38570271