AUA 2018: Assessing the 20-Year Outcomes of Lymph Node Positive Prostate Cancer Patients: A Plea For Lifelong Follow-Up

San Francisco, CA ( Little data are available on oncological outcomes of lymph node metastatic (LNM) prostate cancer (PCa) patients at very long follow-up and on predictors of cancer specific mortality (CSM) in this setting. The authors evaluated the long-term patterns of clinical recurrence (CR) and CSM in a large database of surgically treated LNM PCa patients with at least 20 years of follow-up. 

For the purpose of this study, 615 LNM PCa patients treated with radical prostatectomy (RP) and extended pelvic lymph node dissection at three referral centers in Europe and US between 1987-1997 were included. The primary outcome was CR. Patients were divided into two groups: earlier recurrence (CR within 10 years from surgery) and late recurrence (CR at least 10 years after surgery). Secondary outcomes were CSM and other cause of mortality (OCM). 

Median follow-up for survivors was 227 months. Overall, 206 (33.5%) experienced CR. Median time to CR was 89 months and 20-years CR rate was 39.2%. Overall, 390 and 140 patients died of all cause and CSM during the study period, respectively. Median time to CSM was 110 months. 20-year CSM and OCM rates were 23.9% and 45.5%. Pathological Gleason score (GS) 8-10 (HR 2.0, p=0.009), positive surgical margin (HR 1.73, p=0.009) and 3 LNM (HR 2.0, p=0.004) were predictors of CSM. Overall, 132 (21.4%) patients experienced CR within 10 years from RP. Among those, 99 (75%) died due to PCa. The 20-yrs CSM rate was 78.3% after accounting for OCM (16.6%). GS 8-10 was the only predictor of CSM (HR: 2.9, p=0.002). Of all remaining patients, 69 had CR at least 10 years after RP. Of this group of patients, the vast majority (47; 68.1%) harbored pT3b-T4, 53 (76.8%) had GS7, and 36 (52.2%) had only one LNM. Among these, 32 (46.4%) died from PCa. 20-years CSM rate was 45.7%, after accounting for OCM (13.8%).

In conclusion, among LNM PCa patients, one out of four died due to PCa within 20 years from RP. Although the majority of CR occurred within ten years after RP, node positive patients are still at risk for developing late recurrences. While the impact of CR on CSM is higher in earlier recurrent patients, more than half of men developing recurrence beyond 10 years after RP will eventually die from PCa. Patients harboring LNM at RP should continue to be monitored for a long-term duration and should always be considered at risk of CR and CSM.

Presented by: Marco Bandini, Milan, Italy
Co-Authors: Nicola Fossati, Giorgio Gandaglia, Paolo Dell'Oglio, Emanuele Zaffuto, Carlo Andrea Bravi, Elio Mazzone, Milan, Italy, Felix Preisser, Hamburg, Germany, Matteo Soligo, Rochester, MN, Fabio Muttin, Milan, Italy, Pierre I. Karakiewicz, Montreal, Canada, Markus Graefen, Hamburg, Germany, Jeffrey R. Karnes, Rochester, MN, Derya Tilki, Hamburg, Germany, Francesco Montorsi, Alberto Briganti, Milan, Italy

Written by:  Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA