Cure Possible Despite Positive Lymph Nodes

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ATLANTA—Long-term PSA relapse-free survival after radical prostatectomy (RP) and pelvic lymph node dissection (PLND) is possible in a subset of patients with low volume nodal metastases, a researcher reported at the American Urological Association 2012 annual meeting.

The researcher, Roland Seiler, MD, of the University of Bern, Switzerland, and colleagues evaluated 88 patients with positive lymph nodes and PLND after RP to determine if the patients had a chance of cure. After a median follow-up of 15.2 years, 43 patients (49%) had died from prostate cancer and 17 (19%) had died from other causes.

Thirty-nine patients had one positive lymph node. Of these, 21 (54%) experienced symptomatic progression, including 10 who died from PCa. Nine patients (23%) showed asymptomatic PSA progression only. After 15.2 years, nine (23%) patients have remained completely disease free.

Forty-nine patients had two or more positive lymph nodes (20 had two and 29 had more than two). All of these patients experienced PSA progression; only three (6%) remained without symptomatic progression.

Of the 49 patients, 33 (67%) died from progressive disease. Of 20 patients with asymptomatic PSA progression eight years previously, five have since died from PCa.

Based on study findings, Dr. Seiler stated, “PSA progression by itself does not necessarily mean cancer-related death later.”

He and his colleagues noted that their data are from a period when the extent of PLND was more limited that it is currently. With the more extended PLND used today, outcomes may be even better.

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