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Good outcome for patients with few lymph node metastases after radical retropubic prostatectomy.
Eur Urol. 2008 Aug; 54(2):344-52.EU

Abstract

BACKGROUND

Conflicting results exist regarding the value of an extended pelvic lymph node dissection (PLND) in node-positive patients undergoing radical retropubic prostatectomy (RRP) for clinically localized prostate cancer.

OBJECTIVE

To assess the long-term outcome in node-positive patients who underwent extended PLND followed by RRP.

DESIGN, SETTING, AND PARTICIPANTS

A consecutive series of 122 node positive patients with negative preoperative staging examinations, no neoadjuvant hormonal or radiotherapy, and who underwent extended PLND (>/=10 lymph nodes in the surgical specimen) followed by RRP were analyzed. None of the patients received immediate androgen deprivation therapy (ADT).

INTERVENTION

All patients underwent extended PLND followed by RRP.

MEASUREMENTS

Biochemical recurrence-free survival, cancer-specific, and overall survival were assessed using the Kaplan-Meier technique.

RESULTS AND LIMITATIONS

Median prostate-specific antigen (PSA) was 16ng/ml. At pathological examination 76% of the 122 patients had pT3-pT4 tumours, 50% seminal vesicle infiltration. A median of 22 nodes were removed per patient. Median cancer-specific survival at 5 and 10 yr was 84.5% and 60.1%, respectively. In patients with </=2 or >/=3 positive nodes removed, median cancer-specific survival at 10 yr was 78.6% and 33.4%, respectively (p<0.001). After a median period of 33 mo, 61 of the 122 patients (50%) received ADT, particularly those (69%) with >/=3 positive nodes removed. This retrospective study includes a significant percentage of patients with high tumour burden, and therefore may not reflect current patient series.

CONCLUSIONS

Patients with </=2 positive nodes detected after extended PLND followed by RRP had good long-term results and should not be denied treatment with curative intent. In contrast, prognosis was poor in patients with >/=3 positive nodes, despite extended PLND and despite ADT in 69% of patients.

Authors+Show Affiliations

Department of Urology, University of Bern, Switzerland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18511183

Citation

Schumacher, Martin C., et al. "Good Outcome for Patients With Few Lymph Node Metastases After Radical Retropubic Prostatectomy." European Urology, vol. 54, no. 2, 2008, pp. 344-52.
Schumacher MC, Burkhard FC, Thalmann GN, et al. Good outcome for patients with few lymph node metastases after radical retropubic prostatectomy. Eur Urol. 2008;54(2):344-52.
Schumacher, M. C., Burkhard, F. C., Thalmann, G. N., Fleischmann, A., & Studer, U. E. (2008). Good outcome for patients with few lymph node metastases after radical retropubic prostatectomy. European Urology, 54(2), 344-52. https://doi.org/10.1016/j.eururo.2008.05.023
Schumacher MC, et al. Good Outcome for Patients With Few Lymph Node Metastases After Radical Retropubic Prostatectomy. Eur Urol. 2008;54(2):344-52. PubMed PMID: 18511183.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Good outcome for patients with few lymph node metastases after radical retropubic prostatectomy. AU - Schumacher,Martin C, AU - Burkhard,Fiona C, AU - Thalmann,George N, AU - Fleischmann,Achim, AU - Studer,Urs E, Y1 - 2008/05/21/ PY - 2007/10/19/received PY - 2008/05/12/accepted PY - 2008/5/31/pubmed PY - 2009/6/6/medline PY - 2008/5/31/entrez SP - 344 EP - 52 JF - European urology JO - Eur Urol VL - 54 IS - 2 N2 - BACKGROUND: Conflicting results exist regarding the value of an extended pelvic lymph node dissection (PLND) in node-positive patients undergoing radical retropubic prostatectomy (RRP) for clinically localized prostate cancer. OBJECTIVE: To assess the long-term outcome in node-positive patients who underwent extended PLND followed by RRP. DESIGN, SETTING, AND PARTICIPANTS: A consecutive series of 122 node positive patients with negative preoperative staging examinations, no neoadjuvant hormonal or radiotherapy, and who underwent extended PLND (>/=10 lymph nodes in the surgical specimen) followed by RRP were analyzed. None of the patients received immediate androgen deprivation therapy (ADT). INTERVENTION: All patients underwent extended PLND followed by RRP. MEASUREMENTS: Biochemical recurrence-free survival, cancer-specific, and overall survival were assessed using the Kaplan-Meier technique. RESULTS AND LIMITATIONS: Median prostate-specific antigen (PSA) was 16ng/ml. At pathological examination 76% of the 122 patients had pT3-pT4 tumours, 50% seminal vesicle infiltration. A median of 22 nodes were removed per patient. Median cancer-specific survival at 5 and 10 yr was 84.5% and 60.1%, respectively. In patients with </=2 or >/=3 positive nodes removed, median cancer-specific survival at 10 yr was 78.6% and 33.4%, respectively (p<0.001). After a median period of 33 mo, 61 of the 122 patients (50%) received ADT, particularly those (69%) with >/=3 positive nodes removed. This retrospective study includes a significant percentage of patients with high tumour burden, and therefore may not reflect current patient series. CONCLUSIONS: Patients with </=2 positive nodes detected after extended PLND followed by RRP had good long-term results and should not be denied treatment with curative intent. In contrast, prognosis was poor in patients with >/=3 positive nodes, despite extended PLND and despite ADT in 69% of patients. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/18511183/Good_outcome_for_patients_with_few_lymph_node_metastases_after_radical_retropubic_prostatectomy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(08)00626-X DB - PRIME DP - Unbound Medicine ER -