PURPOSE: In 2003 we reported on the outcome of 88 node-positive patients who underwent radical prostatectomy and pelvic lymph node dissection (PLND) (median 21 nodes) between 1989 and 1999.
Patients with limited nodal disease appeared to have a good chance of long-term survival, even without immediate adjuvant therapy (androgen deprivation therapy (ADT) and/or radiotherapy). The goal of the present study was to update the follow-up in these patients and verify the reported projected probability of survival.
METHODS: The projected 10-year cancer-specific survival (CSS) probability after the initially reported follow-up of 3.2 years was 60% for these node-positive patients. The outcome has been updated after a median follow-up of 15.6 years.
RESULTS: Of the 39 patients with one positive node, 7 (18%) remained biochemically relapse free, 11 (28%) showed biochemical relapse only, and 21 (54%) developed clinical progression. Twenty-two of the 39 patients (57%) never required deferred ADT; 12 (27%) have died of prostate cancer. All patients with 2 (n=20) or >2 (n=29) positive nodes developed biochemical relapse, only 5 (10%) of the 49 experienced no clinical progression. Thirty-nine of the 49(80%) received deferred ADT.
CONCLUSIONS: Biochemical relapse is likely in patients with limited nodal disease after radical prostatectomy and PLND, but for 47% of patients this does not imply death from prostate cancer. Patients with one positive node have a good (75%) 10-year CSS probability and a 20% chance of remaining biochemical relapse-free, even without immediate adjuvant therapy.
Written by:
Seiler R, Studer UE, Tschan K, Bader P, Burkhard FC. Are you the author?
Department of Urology, University of Berne, Switzerland.
Reference: J Urol. 2013 Nov 18. pii: S0022-5347(13)05982-X.
doi: 10.1016/j.juro.2013.11.029
PubMed Abstract
PMID: 24262495
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