The Role of Pelvic Lymph Node Dissection during Radical Prostatectomy in Patients with Gleason Grade 6 Intermediate-Risk Prostate Cancer.

To analyze the benefit of PLND in patients with biopsy Gleason grade≤6, cT≤2b and PSA 10-20ng/ml (main study cohort), as the indication for pelvic lymph node dissection (PLND) during radical prostatectomy (RP) remains uncertain in patients with non-high-risk tumours.

The main study cohort included 1383 patients with low intermediate-risk cancer undergoing RP with or without PLND between 1994 and 2013. Positive lymph node (LN) rates were reported and compared to patients with higher (≥20ng/ml; n=314) and lower (<10ng/ml; n=6861) PSA. Oncological outcome was assessed by Cox-regressions in patients with a minimum follow-up of 5yrs.

In the main study cohort (PSA 10-20ng/ml) PLND was performed in 867 (62.7%) patients with a median number of removed LNs of 11 (IQR 16-6). Positive LNs were detected in 3.3% of these patients. Compared to the main study cohort, patients with preoperatively higher PSA ≥20ng/ml (or lower PSA<10 ng/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 occurred in 20.6% of these men. 5-yr and 10-yr BCR-free survival rates were 82.2% and 75.6% for those with 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.

Positive LNs are rare in patients with Gleason grade≤6, cT≤2b and PSA 10-20ng/ml. Performing PLND had no statistical influence on oncologic outcome and therefore should be decided upon on an individual basis.

Urology. 2016 Mar 08 [Epub ahead of print]

Philipp Mandel, Maximilian C Kriegmair, Valia Veleva, Georg Salomon, Markus Graefen, Hartwig Huland, Derya Tilki

Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, University Hospital Mannheim, Mannheim, Germany., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. Electronic address: .