Good Outcome for Patients with Few Lymph Node Metastases After Radical Retropubic Prostatectomy

BackgroundConflicting results exist regarding the value of an extended pelvic lymph node dissection (PLND) in node-positive patients undergoing radical retropubic prostatectomy (RRP) for clinically localized prostate cancer.ObjectiveTo assess the long-term outcome in node-positive patients who underwent extended PLND followed by RRP.Design, setting, and participantsA consecutive series of 122 node positive patients with negative preoperative staging examinations, no neoadjuvant hormonal or radiotherapy, and who underwent extended PLND (≥10 lymph nodes in the surgical specimen) followed by RRP were analyzed. None of the patients received immediate androgen deprivation therapy (ADT).InterventionAll patients underwent extended PLND followed by RRP.MeasurementsBiochemical recurrence-free survival, cancer-specific, and overall survival were assessed using the Kaplan-Meier technique.Results and limitationsMedian prostate-specific antigen (PSA) was 16 ng/ml. At pathological examination 76% of the 122 patients had pT3–pT4 tumours, 50% seminal vesicle infiltration. A median of 22 nodes were removed per patient. Median cancer-specific survival at 5 and 10 yr was 84.5% and 60.1%, respectively. In patients with ≤2 or ≥3 positive nodes removed, median cancer-specific survival at 10 yr was 78.6% and 33.4%, respectively (p < 0.001). After a median period of 33 mo, 61 of the 122 patients (50%) received ADT, particularly those (69%) with ≥3 positive nodes removed. This retrospective study includes a significant percentage of patients with high tumour burden, and therefore may not reflect current patient series.ConclusionsPatients with ≤2 positive nodes detected after extended PLND followed by RRP had good long-term results and should not be denied treatment with curative intent. In contrast, prognosis was poor in patients with ≥3 positive nodes, despite extended PLND and despite ADT in 69% of patients.