WASHINGTON, DC USA (UroToday.com) - This multicenter group of investigators presented data that the extent of pelvic lymph node dissection (PLND) in men undergoing radical prostatectomy was not associated with ACM or PCSM.
They studied 13,428 radical prostatectomy (RP) patients treated between 1987 and 2006 with RP alone or +/- PLND at 1 of 4 academic medical centers. The decision to perform PLND and its extent were influenced by surgeon choice and disease severity. They analyzed whether the extent of PLND quantified by the LN number [LNN] was associated with ACM and PCSM after adjusting for PSA, biopsy Gleason score, clinical stage, age, and year of surgery. Multivariable Cox proportional hazards regression analysis and competing risk regression analysis were used to analyze the association of parameters with ACM and PCSM, respectively. Planned subset analyses were conducted on patients classified as intermediate- and high-risk and on those with a predicted risk of cancer recurrence >10% at 5-years by the Kattan nomogram. The median follow-up was 48 months. The alpha-level was adjusted for multiple hypotheses testing using Bonferroni method.
Death from prostate cancer occurred in 195 men, and death from competing causes occurred in 711 men. Overall, 4,010 (30%) men did not undergo PLND, 8,993 (67%) had pathologically negative LN, and 425 (3%) had positive LN. The median number of LN removed was 6. Overall, LNN was not significantly associated with ACM or PCSM and similar results were observed among intermediate- and high-risk men and those with a nomogram-predicted risk of recurrence >10%. Among men with pathologically N0 or NX disease, no association between LNN and ACM or PCSM was observed. There were 425 men with LN positive disease and in this subset LNN was associated with improved PCSM, but this did not reach statistical significance after adjustment for multiple hypothesis testing.
They concluded that the therapeutic benefit of a thorough PLND to remove LN distal to the common iliac bifurcation on survival is uncertain.
Presented by Ahmed Abd El-Latif, et al. at the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA
Reported for UroToday by Christopher P. Evans, MD, FACS, Professor and Chairman, Department of Urology, University of California, Davis, School of Medicine.