Pelvic lymph node dissection gives prostate cancer patients good survival outcomes

Results of a retrospective study investigating men with clinically localized prostate cancer who underwent radical retropubic prostatectomy with bilateral pelvic lymph node dissection (PLND) show a higher than expected incidence of LN metastases, but men with nodal involvement had excellent 10-year clinical recurrence-free survival.

Data for the study were extracted from review of a prospectively maintained University of Southern California, Los Angeles prostate cancer database. After excluding men treated preoperatively with radiation or androgen deprivation or whose risk group was indefinable, 2,487 men were identified who underwent prostatectomy and bilateral PLND between July 1988 and June 2008.

One hundred fifty (6.0%) had LN involvement, and of those, 120 (80%) had just one or two positive nodes. About two-thirds of the men with lymph node-positive disease went on to receive adjuvant therapy after surgery.

With a median follow-up of 7.2 years, 5- and 10-year clinical recurrence-free survival rates were 97% and 84%, respectively, for the entire cohort of men with LN metastases and 88% and 80%, respectively, for the subgroup that did not receive adjuvant therapy. The number of positive LNs was not a significant negative predictor of cancer-specific outcomes, likely because of a high rate of adjuvant treatment, said first author Ryan Dorin, MD, of the University of Southern California/Norris Cancer Center.

Co-author Sia Daneshmand, MD, told Urology Times, "These results are consistent with findings from European studies reporting LN-positive rates in the range of 6% to 10% among men with clinically organ-confined disease, and together, the data suggest that the Partin tables underestimate the extent of LN involvement in this subgroup of prostate cancer patients.

"Considering our findings of a risk of LN involvement that is not insignificant and showing that lymphadenectomy can be curative, we recommend performing bilateral PLND in all men undergoing radical prostatectomy for prostate cancer except perhaps for those in the lowest risk group. Furthermore, lymphadenectomy provides definitive information about LN status and thereby enables early institution of ADT, which has been shown in a randomized trial to significantly improve prognosis."