Removal of greater numbers of lymph nodes during radical prostatectomy for intermediate- and high-risk prostate cancer is associated with improved survival, according to data presented at the 22nd annual meeting of the Society of Urologic Oncology.

In a propensity score analysis, removal of 10 to 19 lymph nodes was significantly associated with a 14% decreased risk for death compared with removal of less than 10 lymph nodes among patients with intermediate-risk prostate cancer, Furkan Dursun, MD, of the University of Texas Health San Antonio, reported on behalf of his research team. Removal of 20 or more lymph nodes was significantly associated with a 39% decreased risk for death among patients with high-risk prostate cancer.

The study included 103,250 patients identified using the National Cancer Database. Of these, 74.2% and 25.8% had intermediate- and high-risk prostate cancer. The number of excised lymph nodes was less than 10 for 80.5% of patients, 10 to 19 for 15.9%, and 20 or more for 3.6%.

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In both the intermediate- and high-risk groups, pathologically proven lymph node-positive disease rates were significantly higher among patients with 20 or more excised lymph nodes compared with those who had fewer than 10 and 10-19 excised lymph nodes (9.25% vs 1.53% and 4.45% for intermediate-risk patients and 25.25% vs 5.65% and 15.53%, respectively, for high-risk patients).

Dr Dursun and colleagues defined intermediate-risk prostate cancer as cT2b-2c and/or PSA level 10-20 ng/mL and/or Grade Group 2 or 3 disease and high-risk prostate cancer as cT3 or higher and/or PSA level greater than 20 ng/mL, and/or Grade Group 4 or 5.


Dursun F, Elshabrawy A, Wang H, et al. Impact of extent of lymphadenectomy on all-cause mortality in patients with intermediate- and high-risk prostate cancer managed with radical prostatectomy. Presented at 22nd annual meeting of the Society of Urologic Oncology, December 1-3, 2021. Poster 143.