Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
6165441 | Urology | 2016 | 6 Pages |
ObjectiveTo analyze the benefit of pelvic lymph node dissection (PLND) in patients with biopsy Gleason gradeââ¤â6, cTââ¤â2b, and prostate-specific antigen (PSA) 10-20âng/mL (main study cohort), as the indication for PLND during radical prostatectomy remains uncertain in patients with nonhigh-risk tumors.Materials and MethodsThe main study cohort included 1383 patients with low intermediate-risk cancer undergoing radical prostatectomy with or without PLND between 1994 and 2013. Positive lymph node (LN) rates were reported and compared to patients with higher (â¥20âng/mL; nâ=â314) and lower (<10âng/mL; nâ=â6861) PSA. Oncological outcome was assessed by Cox regressions in patients with a minimum follow-up of 5years.ResultsIn the main study cohort (PSA 10-20âng/mL), PLND was performed in 867 (62.7%) patients with a median number of removed LNs of 11 (interquartile range 16-6). Positive LNs were detected in 3.3% of these patients. Compared to the main study cohort, patients with preoperatively higher PSA ⥠20âng/mL (or lower PSAâ<â10âng/ml) underwent PLND in 83.8% (32.7%) of the cases, with 8.0% (1.8%) showing positive LNs. Median follow-up in the main study cohort was 84.5 months. Biochemical recurrence (BCR) occurred in 20.6% of these men. The 5-year and 10-year BCR-free survival rates were 82.2% and 75.6% for those with PLND, and 83.4% and 75.8% for patients without PLND. PLND was not a significant factor influencing BCR-free, metastasis-free, or cancer-specific survival in the main study cohort.ConclusionPositive LNs are rare in patients with Gleason gradeââ¤â6, cTââ¤â2b, and PSA 10-20âng/mL. Performing PLND had no statistical influence on oncologic outcome and therefore should be decided upon on an individual basis.