Impact of Radical Prostatectomy on Long-Term Oncologic Outcomes in a Matched-Cohort of Men with Pathologic Node-Positive Prostate Cancer Managed with Castration

Long-term data supporting the role of primary tumor resection in node-positive prostate cancer (PCa) are lacking. This study evaluates the impact of adding radical retropubic prostatectomy (RRP) to surgical castration on long-term oncologic outcomes in pathological node-positive (pN+) PCa.

Men who underwent pelvic lymphadenectomy and orchiectomy within 90 days for pN+ PCa were identified (1966-1995). Men who underwent RRP in addition to orchiectomy (RRP-O) were matched 1:1 to men who underwent orchiectomy alone based on age, year of surgery, clinical grade, clinical T-stage, number of positive nodes, and pre-operative serum PSA (after 1987). Kaplan-Meier and Cox regression analyses compared cancer-specific (CSS) and overall survival (OS).

The matched-cohort included 158 men (79 in each group). Among men undergoing orchiectomy alone, 76 died, with 60 dying from PCa. Among patients undergoing RRP-O, 70 died, with 28 dying from PCa. On Kaplan-Meier analyses, RRP-O versus orchiectomy alone was associated with prolonged CSS (20-year CSS: 59% versus 18%; log-rank p<0.001) and OS (20-year OS: 22% versus 9%; log-rank p<0.001). In Cox models, RRP-O versus orchiectomy alone was associated with improved CSS (HR=0.28, 95%CI=0.17-0.46, p<0.001) and OS (HR=0.48, 95%CI=0.34-0.66, p<0.001). Findings were similar in the subset with available pre-operative PSA.

With nearly the entire cohort having lifelong follow up, this study demonstrates that the addition of RRP to surgical castration for pN+ PCa is associated with improved CSS and OS. When technically feasible in well-selected patients, aggressive loco-regional resection should be considered in node-positive PCa as part of a multi-modal approach.

The Journal of urology. 2017 Jan 24 [Epub ahead of print]

Bimal Bhindi, Laureano J Rangel, Ross J Mason, Matthew T Gettman, Igor Frank, Eugene D Kwon, Matthew K Tollefson, R Houston Thompson, Stephen A Boorjian, R Jeffrey Karnes

Department of Urology, Mayo Clinic, Rochester, MN, USA., Department of Biostatistics, Mayo Clinic, Rochester, MN, USA., Department of Urology, Mayo Clinic, Rochester, MN, USA. Electronic address: .