767 PATHOLOGICAL AND ONCOLOGIC OUTCOMES FOR MEN WITH POSITIVE LYMPH NODES AT RADICAL PROSTATECTOMY: 30-YEAR EXPERIENCE FROM A SINGLE INSTITUTION

Abstract

You have accessJournal of UrologyProstate Cancer: Advanced II1 Apr 2012767 PATHOLOGICAL AND ONCOLOGIC OUTCOMES FOR MEN WITH POSITIVE LYMPH NODES AT RADICAL PROSTATECTOMY: 30-YEAR EXPERIENCE FROM A SINGLE INSTITUTION Phillip Pierorazio, Jeffrey Mullins, Ashley Ross, Edward Schaeffer, Alan Partin, Misop Han, Patrick Walsh, and Trinity Bivalacqua Phillip PierorazioPhillip Pierorazio Baltimore, MD More articles by this author , Jeffrey MullinsJeffrey Mullins Baltimore, MD More articles by this author , Ashley RossAshley Ross Baltimore, MD More articles by this author , Edward SchaefferEdward Schaeffer Baltimore, MD More articles by this author , Alan PartinAlan Partin Baltimore, MD More articles by this author , Misop HanMisop Han Baltimore, MD More articles by this author , Patrick WalshPatrick Walsh Baltimore, MD More articles by this author , and Trinity BivalacquaTrinity Bivalacqua Baltimore, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.854AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lymph node (LN) metastases at radical prostatectomy (RP) are a poor prognostic indicator with regards to oncologic outcomes. We report the 30-year experience of single institution with regard to LN metastases in men with clinically localized prostate cancer. METHODS The Johns Hopkins Radical Prostatectomy Database (1982-2011) was queried for men with node-positive adenocarcinoma of the prostate (N+PC). 505 (2.5%) of 19,633 men were identified. Survival analysis was completed using the Kaplan-Meier method and proportional hazard regression models were created to identify predictors of outcome in this cohort. RESULTS Median age was 59.5 years (range 38-76) and the majority of patients were Caucasian (452, 89.5%). Median PSA was 10.1 ng/mL (0.4-129), only 153 (30.3%) and 79 (15.6%) had clinical stage T2b and T2c/T3 respectively; 162 (32.1%), 232 (45.9%), 56 (11.1%), 38 (7.7%) and 4 (0.8%) men had Gleason 2-6, 7, 8, 9 and 10 at biopsy. At pathologic evaluation, 26 (5.1%), 275 (54.5%), 85 (16.9%), 115 (22.9%) and 2 (0.4%) had Gleason 2-6, 7, 8, 9 and 10 respectively. Median total and positive nodes were 13.2 (1-41) and 1.7 (1-12) respectively. 135 patients had a dominant nodule localized to one side of the prostate; in these patients 80 (59.3%) demonstrated positive LN on the ipsilateral side, 28 (20.7%) had contralateral positive LN and 15 (11.1%) had bilateral positive LN. 15-year biochemical-recurrence free, metastases-free and cancer-specific survival were 7.1%, 41.5% and 57.5% respectively. Predictors of biochemical-recurrence, metastastes and death from prostate cancer in multivariable analysis included Gleason sum at RP and percent of positive LN; notably total LN dissected did not predict outcome. CONCLUSIONS In this highly-selected RP cohort, men with N+PC at RP can experience a durable long-term metastases-free and cancer-specific survival. Predictors of survival include Gleason sum and percentage of positive LN. While total number of LN dissected did not predict outcome, upwards of 30% of men with N+PC will have positive LN contralateral to the primary prostatic lesion highlighting the importance of a thorough, bilateral pelvic LN dissection. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e313 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Phillip Pierorazio Baltimore, MD More articles by this author Jeffrey Mullins Baltimore, MD More articles by this author Ashley Ross Baltimore, MD More articles by this author Edward Schaeffer Baltimore, MD More articles by this author Alan Partin Baltimore, MD More articles by this author Misop Han Baltimore, MD More articles by this author Patrick Walsh Baltimore, MD More articles by this author Trinity Bivalacqua Baltimore, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...