Single Positive Lymph Node Prostate Cancer Can Be Treated Surgically without Recurrence.

PURPOSE/OBJECTIVES - To investigate pN1 prostate cancer (PCa) patients treated surgically without immediate adjuvant treatment.

MATERIALS AND METHODS - We analyzed the database of 2316 patients at our institution who underwent robot-assisted radical prostatectomy (RARP)/radical prostatectomy (RP) between July 2005 and November 2012.

87 patients with pN1 PCa and received no neoadjuvant and immediate adjuvant therapy were included in the study. Included pN1 PCa patients were followed up for median of 60 months. Biochemical recurrence (BCR)-free survival, metastasis-free survival (MFS), cancer specific survival (CSS), and overall survival (OS) rates were determined by using Kaplan-Meier analysis. Cox regression analysis was performed to investigate the impact of prostate-specific antigen (PSA) level, Gleason score, extraprostatic extension, seminal vesicle invasion, perineural invasion, lymphovascular invasion, positive surgical margin, tumor volume, early post-operative PSA(6 weeks), PSA nadir, lymph node yield, and number of pathologically positive lymph nodes on survival.

RESULTS - The 5-year OS rate of patients was 86.1%, while the CSS rate was 89.6%. The metastasis-free and BCR-free survival rates were 71% and 19.1%, respectively, and each was significantly correlated with the number of positive lymph nodes on log rank tests (p = 0.004 and p = 0.039, respectively). The presence of 2 or more pathologically positive LNs (HR:2.20; 95% CI 1.30-3.72; p = 0.003) and a Gleason score ≥8 (HR: 2.40;95% CI: 1.32-4.38; p = 0.04) were significant negative predictors of BCR free survival on multivariable regression analysis. Furthermore, the presence of 2 or more positive lymph nodes (HR: 1.06; 95% CI 1.01-1.11; p = 0.029) were significant negative predictors of metastasis-free survival on multivariable regression analysis. Additionally, in the patients who had no BCR without adjuvant treatment 9 patients out of 10 (90%) had single positive LN and 5 patients out of 10 (50%) had Gleason score 7. Therefore, single positive LN, and Gleason scores ≤7 have significantly low risk of disease progression.

CONCLUSIONS - pN1 PCa patients have heterogenous clinical courses. Patients with single positive LN, and Gleason scores ≤7 have low risk of recurrence. Close observation with delayed adjuvant hormone therapy can be considered in these patients.

PloS one. 2016 Mar 31*** epublish ***

Dae Keun Kim, Kyo Chul Koo, Ali Abdel Raheem, Ki Hong Kim, Byung Ha Chung, Young Deuk Choi, Koon Ho Rha

Department of Urology, CHA Seoul Station Medical Center, CHA University, CHA Medical School, Seoul, Republic of Korea., Department of Urology, Urological Science Institute, Yonsei University, College of Medicine, Seoul, Republic of Korea., Department of Urology, Urological Science Institute, Yonsei University, College of Medicine, Seoul, Republic of Korea., Department of Urology, Soonchunhyang University Cheonan Hospital, Cheonan, Chungcheongnam-do, Republic of Korea., Department of Urology, Urological Science Institute, Yonsei University, College of Medicine, Seoul, Republic of Korea., Department of Urology, Urological Science Institute, Yonsei University, College of Medicine, Seoul, Republic of Korea., Department of Urology, Urological Science Institute, Yonsei University, College of Medicine, Seoul, Republic of Korea.