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Long-term outcome after radical prostatectomy for patients with lymph node positive prostate cancer in the prostate specific antigen era.
J Urol. 2007 Sep; 178(3 Pt 1):864-70; discussion 870-1.JU

Abstract

PURPOSE

While the incidence of lymph node positive prostate cancer has decreased during the prostate specific antigen era, the optimal treatment of these patients remains in question. We examined the impact of lymph node metastases on the outcome of patients following radical prostatectomy and investigated prognostic factors that affect survival.

MATERIALS AND METHODS

We identified 507 men treated with radical prostatectomy between 1988 and 2001 who had lymph node positive disease. Of the 507 patients 455 (89.7%) were treated with adjuvant hormonal therapy. Median followup was 10.3 years (IQR 6.1-13.5). Postoperative survival rates were estimated using the Kaplan-Meier method and the impact of various clinicopathological factors on outcome was analyzed using Cox proportional hazard regression models.

RESULTS

Ten-year cancer specific survival for patients with positive lymph nodes was 85.8% with 56% of the men free from biochemical recurrence at last followup. On multivariate analysis pathological Gleason score 8-10 (p = 0.004), positive surgical margins (p = 0.016), nondiploid tumor ploidy (p = 0.023) and 2 or greater positive nodes (p = 0.001) were adverse predictors of cancer specific survival. Tumor stage, year of surgery and total number of nodes removed did not significantly affect outcome. Adjuvant hormonal therapy decreased the risk of biochemical recurrence (p <0.001) and local recurrence (p = 0.004) but it was not associated with systemic progression (p = 0.4) or cancer specific survival (p = 0.4).

CONCLUSIONS

Radical prostatectomy may offer long-term survival to patients with lymph node positive prostate cancer. Gleason score, margin status, tumor ploidy and the number of involved nodes predict survival, while the role of adjuvant hormonal therapy continues to be defined.

Authors+Show Affiliations

Department of Urology and Division of Biostatistics, Mayo Medical School and Mayo Clinic, Rochester, Minnesota 55905, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17631342

Citation

Boorjian, Stephen A., et al. "Long-term Outcome After Radical Prostatectomy for Patients With Lymph Node Positive Prostate Cancer in the Prostate Specific Antigen Era." The Journal of Urology, vol. 178, no. 3 Pt 1, 2007, pp. 864-70; discussion 870-1.
Boorjian SA, Thompson RH, Siddiqui S, et al. Long-term outcome after radical prostatectomy for patients with lymph node positive prostate cancer in the prostate specific antigen era. J Urol. 2007;178(3 Pt 1):864-70; discussion 870-1.
Boorjian, S. A., Thompson, R. H., Siddiqui, S., Bagniewski, S., Bergstralh, E. J., Karnes, R. J., Frank, I., & Blute, M. L. (2007). Long-term outcome after radical prostatectomy for patients with lymph node positive prostate cancer in the prostate specific antigen era. The Journal of Urology, 178(3 Pt 1), 864-70; discussion 870-1.
Boorjian SA, et al. Long-term Outcome After Radical Prostatectomy for Patients With Lymph Node Positive Prostate Cancer in the Prostate Specific Antigen Era. J Urol. 2007;178(3 Pt 1):864-70; discussion 870-1. PubMed PMID: 17631342.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term outcome after radical prostatectomy for patients with lymph node positive prostate cancer in the prostate specific antigen era. AU - Boorjian,Stephen A, AU - Thompson,R Houston, AU - Siddiqui,Sameer, AU - Bagniewski,Stephanie, AU - Bergstralh,Erik J, AU - Karnes,R Jeffrey, AU - Frank,Igor, AU - Blute,Michael L, Y1 - 2007/07/16/ PY - 2007/01/17/received PY - 2007/7/17/pubmed PY - 2007/10/3/medline PY - 2007/7/17/entrez SP - 864-70; discussion 870-1 JF - The Journal of urology JO - J Urol VL - 178 IS - 3 Pt 1 N2 - PURPOSE: While the incidence of lymph node positive prostate cancer has decreased during the prostate specific antigen era, the optimal treatment of these patients remains in question. We examined the impact of lymph node metastases on the outcome of patients following radical prostatectomy and investigated prognostic factors that affect survival. MATERIALS AND METHODS: We identified 507 men treated with radical prostatectomy between 1988 and 2001 who had lymph node positive disease. Of the 507 patients 455 (89.7%) were treated with adjuvant hormonal therapy. Median followup was 10.3 years (IQR 6.1-13.5). Postoperative survival rates were estimated using the Kaplan-Meier method and the impact of various clinicopathological factors on outcome was analyzed using Cox proportional hazard regression models. RESULTS: Ten-year cancer specific survival for patients with positive lymph nodes was 85.8% with 56% of the men free from biochemical recurrence at last followup. On multivariate analysis pathological Gleason score 8-10 (p = 0.004), positive surgical margins (p = 0.016), nondiploid tumor ploidy (p = 0.023) and 2 or greater positive nodes (p = 0.001) were adverse predictors of cancer specific survival. Tumor stage, year of surgery and total number of nodes removed did not significantly affect outcome. Adjuvant hormonal therapy decreased the risk of biochemical recurrence (p <0.001) and local recurrence (p = 0.004) but it was not associated with systemic progression (p = 0.4) or cancer specific survival (p = 0.4). CONCLUSIONS: Radical prostatectomy may offer long-term survival to patients with lymph node positive prostate cancer. Gleason score, margin status, tumor ploidy and the number of involved nodes predict survival, while the role of adjuvant hormonal therapy continues to be defined. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/17631342/Long_term_outcome_after_radical_prostatectomy_for_patients_with_lymph_node_positive_prostate_cancer_in_the_prostate_specific_antigen_era_ L2 - https://www.jurology.com/doi/10.1016/j.juro.2007.05.048?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -