EAU 2011 - More extensive pelvic lymph node dissection is associated with reduced risk of cancer progression in node negative organ confined prostate cancer patients - Session Highlights

VIENNA, AUSTRIA (UroToday.com) - Previously, Dr. Urs Studer has reported that an extended pelvic lymph node dissection for prostate cancer (CaP) is associated with better oncologic outcomes, even when the nodes are pathologically negative.

However, controversy exists regarding this. These authors hypothesized that more extensive nodal dissections might influence biochemical recurrence (BCR) of node negative (N0) organ confined CaP in a large series of patients submitted to anatomically defined PLND.

The study included 1,368 consecutive patients with pT2, N0 and surgical margin negative (SM-) CaP treated with extended PLND (ePLND) and RP for clinically localized CaP at a single referral center. All patients underwent an anatomically defined ePLND (including removal of obturator, external iliac and hypogastric nodes). Patients were divided into two groups according to the extent of PLND: <20 and ≥20 lymph nodes removed. Pre-operative as well as pathological variables were available for all patients. BCR at 2, 5 and 8 years after surgery in the overall patient population and in each group was calculated. The association between the extent of PLND and BCR - after accounting for pre-operative PSA and age at surgery, prostate weight and pathological Gleason score - was determined. Overall, mean number of nodes removed was 16.6, and pathological Gleason sum was 6, 3+4 ,4+3 and 8-10 in 56.1, 32.4, 8.4 and 3.1% of patients, respectively. Mean PSA was 7.86 ng/ml and mean prostate weight was 53.2 grams. No patient received any adjuvant treatment. Of all patients, 984 (71.9%) and 384 (28.1%) had <20 and ≥20 lymph nodes removed, respectively. The two groups of patients did not differ in terms of pre-operative or pathological characteristics. BCR-free survival at 5, 8,10 years was 88, 82, 75% and 93, 90, 90% in patients with <20 and ≥20 lymph nodes removed, respectively (p=0.018). The association between the extent of PLND and BCR-free survival was maintained at multivariable analysis after accounting for age at surgery, PSA, pathological Gleason sum and prostate weight (p=0.04). Patients with ≥20 lymph nodes removed had a 1.5 chance of being free from cancer recurrence after surgery. The team concluded that whether this is due to the removal of micro-metastatic disease or to a better nodal staging in node negative patients remains to be clarified.


Presented by Alberto Briganti, MD at the 26th Annual European Association of Urology (EAU) Congress - March 18 - 21, 2011 - Austria Centre Vienna, Vienna, Austria


The opinions expressed in this article are those of the UroToday.com Contributing Medical Editor and do not necessarily reflect the viewpoints of the European Association of Urology (EAU)


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