MP56-04 RECURRENCE PATTERN IN LYMPH NODE POSITIVE PROSTATE CANCER PATIENTS AFTER EXTENDED PELVIC LYMPHADENECTOMY AND RADICAL PROSTATECTOMY – THE NATURAL COURSE OF DISEASE

Abstract

You have accessJournal of UrologyProstate Cancer: Localized III1 Apr 2015MP56-04 RECURRENCE PATTERN IN LYMPH NODE POSITIVE PROSTATE CANCER PATIENTS AFTER EXTENDED PELVIC LYMPHADENECTOMY AND RADICAL PROSTATECTOMY – THE NATURAL COURSE OF DISEASE Silvan Boxler, Tobias Gross, George N. Thalmann, Urs E. Studer, and Martin Spahn Silvan BoxlerSilvan Boxler More articles by this author , Tobias GrossTobias Gross More articles by this author , George N. ThalmannGeorge N. Thalmann More articles by this author , Urs E. StuderUrs E. Studer More articles by this author , and Martin SpahnMartin Spahn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2068AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Aggressive local surgical treatment of advanced prostate cancer has gained broad acceptance. The importance of standardised extended lymphadenectomy and the role played by the anatomic extent of lymph node involvement have been elucidated. Scant data exist on the natural course of the disease after radical prostatectomy with lymph node involvement and no immediate adjuvant therapy, particularly regarding the incidence of metastases or pelvic recurrence. METHODS 200 lymph node-positive patients underwent radical prostatectomy and standardized extended lymphadenectomy between 03/1990 and 06/2013 at our department without any neoadjuvant or immediate adjuvant therapy (androgen deprivation therapy (ADT) or radiation therapy). Location of recurrence, time to recurrence, survival, and time to start of ADT were analyzed. RESULTS The median age of the patients at radical prostatectomy was 64 years (range 45-76 y). Median follow up was 68 months (range 3-253 mos). The median number of lymph nodes removed was 26 (range 6-75 nodes). The median number of positive lymph nodes was 2 (range 1-21 nodes). 50 patients had persistently elevated prostate-specific antigen 3 months after surgery and were excluded from this analysis. In the remaining 150 patients median time to biochemical recurrence was 26 months (range 5-202 mos) and median overall survival was 86 months (range 12-232 mos). 66 of the 150 patients (44%) had recurrence with distant or bone metastases, 51 (34%) had recurrence in the pelvis either in the prostatic bed or in pelvic lymph nodes. Only 24 of these 51 patients had either exclusive local recurrence (n=15) or exclusive recurrence in pelvic lymph nodes (n=5) or combined local and pelvic lymph node recurrence (n=4). The other 27 patients had concomitant distant or bone metastases. In 33 of the 150 patients (22%) with a median follow up of 47 months ( range 4-232 mos) no recurrence has yet occurred. 52 patients were still alive 10 years after surgery. Median time from operation to initiation of anti-hormonal treatment was 47 months (range 4-175 mos). Five years after surgery, 28 patients still had not received ADT. CONCLUSIONS Some patients with lymph node-positive prostate cancer have the chance to be cured by surgery. The majority of patients have recurrent disease either in the pelvis combined with distant metastases, or have distant metastases only. Local adjuvant therapy (e.g. radiation therapy) could hardly improve their outcome. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e682 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Silvan Boxler More articles by this author Tobias Gross More articles by this author George N. Thalmann More articles by this author Urs E. Studer More articles by this author Martin Spahn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...