They evaluated biochemical recurrence (BCR) in 280 node positive cases who underwent radical prostatectomy (RP) between 2006-2018 at their institution. Cases with prior treatment and known metastasis at the time of surgery were excluded. Parameters recorded included the number & size of positive LN. Size & GG of largest MET & ENE were also noted.
Dr. Alanee then summarized the results from this study. Average follow up period was 13.4 months. The Average number of LN retrieved was 14.7 with an average of 2 positive LN per case. ENE was identified in 99/244 (41%). Size of the largest positive LN was 10 mm or less in 71% of the cases and the size of the largest MET was < 2 mm (micrometastasis) in 107/261 cases (41%). A solitary LN positive was found in 166/280 (59%) of the cases, 95/280 (34%) had 2-4 LN positive, and 19/280 (7%) had 5 or more LN positive. GG of the MET was as follows GG1-2: 29/224(13%); GG3: 27/224 (12%); GG4-5: 168/224 (75%). Metastatic foci > 2 mm in size (macrometastasis), higher LN GG, higher number of positive LN (categorized as 1, 2-4 and > 5) and the presence of ENE were significantly associated with BCR. No significant differences were observed in unilateral vs bilateral involvement of the LN.
Dr. Alanee concluded his talk with a summary that the current TNM classification for PCa includes only N0 and N1 categories. It does not stratify based on the characteristics of the LN metastasis. In our study, we demonstrate that these characteristics impact the clinical outcome and should closely be examined in patients with node-positive disease identified after prostatectomy.
Presented by: Shaheen Alanee, MD, Vattikuti Urology Institute, Henry Ford Health System
Written by: Abhishek Srivastava, MD, Society of Urologic Oncology Fellow, Fox Chase Cancer Center, Philadelphia, PA, Twitter: @shekabhishek at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois