The following article is part of conference coverage from the 2018 American Urological Association meeting in San Francisco. Renal and Urology News’ staff will be reporting live on medical studies conducted by urologists and other specialists who are tops in their field in kidney stones, prostate cancer, kidney cancer, bladder cancer, enlarged prostate, and more. Check back for the latest news from AUA 2018. 

SAN FRANCISCO—Node-positive prostate cancer (PCa) is becoming more widespread for reasons other than changes in screening practices, Christopher P. Filson, MD, MS, of Emory University School of Medicine in Atlanta, reported at the American Urological Association 2018 annual meeting.

Of 76,630 radical prostatectomy patients from the National Surveillance, Epidemiology, and End Results registry, 58.6% had a lymphadenectomy during 2010 to 2014. Use of lymphadenectomy significantly increased over that time from 55% in 2010 to 66% in 2014. A subset of procedures involved examination of 10 or more or 15 or more lymph nodes. From 2010 to 2014, lymphadenectomy with removal of 10 or more nodes significantly increased from 24.0% to 30.8% and, with removal of 15 or more nodes, from 10.9% to 14.7%.

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The proportion of PCa patients with positive lymph nodes increased overall from 2.4% to 4.7% in 2014. Among lymphadenectomy patients, the same trend persisted for those with 10 or more nodes removed, although not those with 15 or more nodes removed. The team adjusted for confounders including patient age, race/ethnicity, registry, clinical stage, PSA level, Gleason grade, and number of positive biopsy cores.

“Our study confirmed that the incidence of positive lymph nodes increased by 37% from 2010 to 2014 among men at high-risk of lymph node metastases, independent of changes in performance or extent of lymphadenectomy,” Dr Filson told Renal & Urology News. “In parallel, receipt of prostatectomy increased markedly by 15%, lymph node dissection by 18%, and extended lymph node dissection by 56%. Some suggest that screening practices, such as the 2012 USPSTF [US Preventive Services Task Force] recommendations, have influenced the incidence of advanced prostate cancer. More aggressive surgical management of high risk prostate cancer patients should also be acknowledged. Understanding the impact of these surgical trends on patient survival will be critical to improving care moving forward.”

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Taylor M, Henry M, Kim F, Master V, Alemozaffar M, Pattaras J, and Filson C. Rising prevalence of node-positive prostate cancer among men treated with radical prostatectomy. Oral presentation at the American Urological Association 2018 annual meeting, San Francisco, May 18 – 21. Abstract PD52-08.