PCa-Specific Survival Can Be Good Even with Positive Nodes

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ATLANTA—Prostate cancer (PCa) patients with lymph node positive disease found at radical prostatectomy (RP) can experience durable cancer-specific and metastases-free survival, researchers reported at the American Urological Association 2012 annual meeting.

A team at Johns Hopkins University in Baltimore led by Phillip M. Pierorazio, MD, analyzed data from 505 RP patients with lymph node positive disease. Subjects had a median age of 59.5 years. At pathologic evaluation, 26 (5.1%), 275 (54.5%), 85 (16.9%), 115 (22.9%), and two (0.4%) had Gleason 2-6, 7, 8, 9, and 10 disease, respectively. The median number of total and positive lymph nodes was 13.2 and 1.7, respectively.

A total of 135 patients had a dominant nodule localized to one side of the prostate. Of these patients, 80 (59.3%) demonstrated positive lymph nodes on the ipsilateral side, 28 (20.7%) had contralateral positive lymph nodes, and 15 (11.1%) had bilateral positive lymph nodes.

The 15-year biochemical recurrence-free survival, metastases-free, and cancer-specific survival rates were 7.1%, 41.5%, and 57.5%, respectively.

In multivariate analysis, predictors of biochemical recurrence, metastases, and PCa-related death included a high Gleason score and high positive lymph node density at RP. The total number of lymph nodes dissected did not predict outcome.

“The take-home message from this study is that we recommend a thorough bilateral pelvic lymph node dissection in all patients, especially those at risk of lymph node positive disease,” Dr. Pierorazio said.

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