RADICAL PROSTATECTOMY WITH EXTENDED PELVIC LYMPH NODE DISSECTION: SHORT-TERM ONCOLOGICAL OUTCOMES IN PATIENS WITH NODAL METASTASES. IS CURE POSSIBLE WITHOUT SYSTEMIC TREATMENT?
Authors:
Michal Staník 1; Jan Doležel 1,2; Ivo Čapák 1; Daniel Macík 1; Jiří Jarkovský 3; Eva Lžičařová 4; Marcela Vagundová 5; Martin Šustr 1; David Miklánek 1
Authors‘ workplace:
Oddělení onkourologie, MOÚ Brno
1; Centrum robotické chirurgie Vysočina, Nemocnice sv. Zdislavy, Mostiště
2; Institut biostatistiky a analýz, Brno
3; Oddělení onkologické a experimentální patologie, MOÚ Brno
4; Cedelab, Laboratoř patologie a klinické cytologie, Nemocnice sv. Zdislavy, Mostiště
5
Published in:
Ces Urol 2015; 19(2): 137-144
Category:
Original article
Overview
Radical prostatectomy with extended pelvic lymph node dissection: short-term oncological outcomes in patiens with nodal metastases. Is cure possible without systemic treatment?
Aims:
Lymph node metastasis is an unfavorable prognostic factor in prostate cancer. The benefit of pelvic lymph node dissection remains controversial. The aim of our study was to evaluate three-year oncological results and assess the potential of locoregional therapy consisting of radical prostatectomy (RP) with extended pelvic lymph node dissection (ePLND). We also evaluated the 3-year survival rate in patients without androgendeprivation therapy (ADT).
Methods:
Eighty-six patients (64 MOÚ, 22 Mostiště) with nodal metastases who underwent RP + ePLND between August 2007 and March 2014 were included in this study. ePLND included a minimum of external iliac, obturator and internal iliac node dissection. Adjuvant or early salvage RT was performed in 69 (80 %) patients. Median follow-up was 30 months. The Kaplan-Meier model was used to evaluate the survival rate.
Results:
Stages pT2, pT3a, pT3b and pT4 were seen in 20 %, 23 %, 55 % and 2 % of the patients respectively. The median PSA was 14 ng/ml (IQR 8–23). The median number of removed and metastatic lymph nodes was 18 (IQR 14–22) and 2 (range 1–9) respectively. Three-year overall and cancerspecific survival was 93 % and 97 %. The proportion of patients without biochemical recurrence and with delayed ADT after three years was 66 % and 64 % respectively. Postoperatively, median PSA was 0,029 (IQR 0,007–0,135). A maximum of two positive lymph nodes (p = 0,048) and a postoperative PSA lower than 0,01 ng/ml (p = 0,018) were significantly associated with the risk of biochemical recurrence.
Conclusion:
Patients with nodal metastases comprise a heterogeneous group. In a subset with minimal nodal involvement, the locoregional treatment may be curative. The results imply that a substantial number of patients may benefit through delay in the biochemical recurrence and the need for ADT. Further studies are needed to better define the need for RT and ADT in this group of the patients.
Key words:
Antineoplastic agents-hormonal, lymph node excision, prostatic neoplasms, radiotherapy.
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Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
2015 Issue 2
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