OBJECTIVE: To evaluate the impact of an extended pelvic lymph node (LN) dissection (EPLND) on the oncologic outcomes of men with LN-positive prostate cancer.
METHODS: Patients were identified who underwent an open radical prostatectomy by one of two surgeons at the Johns Hopkins Hospital between 1992 and 2003. The first surgeon routinely performed a limited pelvic LN dissection (LPLND), whereas the second performed an EPLND. Men with positive LNs from each cohort were compared for differences in oncologic outcomes.
RESULTS: Positive LNs were found in 94 men (2.2%), 21 (22.3%) with an LPLND and 73 (77.7%) with an EPLND. On average, LPLND and EPLND yielded 11.4 and 14.6 nodes, respectively (P = .022). The two groups were similar in terms of the number of positive LNs (1.4 vs 1.8, P = .223) and the proportion of patients with < 15% positive nodes (57.1% vs 69.9%, P = .300). At a median follow-up of 10.5 years, patients who underwent an EPLND had superior oncologic outcomes compared with the LPLND group: 5-year biochemical recurrence-free survival of 30.1% vs 7.1% (P = .018), 10-year metastasis-free survival of 62.2% vs 22.2% (P = .035), and 10-year cancer-specific survival of 83.6% vs 52.6% (P = .199). This analysis demonstrated an augmented improvement in biochemical recurrence-free survival in men with < 15% positive nodes.
CONCLUSION: In addition to affording valuable staging information, an EPLND may confer a therapeutic benefit to patients found to have positive LNs at the time of radical prostatectomy.
Written by:
Bivalacqua TJ, Pierorazio PM, Gorin MA, Allaf ME, Carter HB, Walsh PC. Are you the author?
The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
Reference: Urology. 2013 Sep;82(3):653-9.
doi: 10.1016/j.urology.2013.03.086
PubMed Abstract
PMID: 23987158
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