PD52-08 RISING PREVALENCE OF NODE-POSTIVE PROSTATE CANCER AMONG MEN TREATED WITH RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life & Shared Decision Making III1 Apr 2018PD52-08 RISING PREVALENCE OF NODE-POSTIVE PROSTATE CANCER AMONG MEN TREATED WITH RADICAL PROSTATECTOMY Melissa Taylor, Mark Henry, Frances Kim, Viraj Master, Mehrdad Alemozaffar, John Pattaras, and Christopher Filson Melissa TaylorMelissa Taylor More articles by this author , Mark HenryMark Henry More articles by this author , Frances KimFrances Kim More articles by this author , Viraj MasterViraj Master More articles by this author , Mehrdad AlemozaffarMehrdad Alemozaffar More articles by this author , John PattarasJohn Pattaras More articles by this author , and Christopher FilsonChristopher Filson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2360AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is a growing concern about rising incidence of more advanced prostate cancer in the setting of relaxed guidelines for prostate cancer screening. Increases in node-positive disease may be explained by changing patterns of use of lymphadenectomy. We examined trends in node-positive prostate cancer among men treated with radical prostatectomy in the context of varying lymph node counts. METHODS We used national Surveillance, Epidemiology, and End Results registry data to identify prostate cancer patients treated with radical prostatectomy from 2010-2014. We then identified subgroups with receipt of lymphadenectomy, lymphadenectomy with 10+ lymph nodes, and lymphadenectomy with 15+ lymph nodes. Among those groups, we identified the proportion with positive lymph nodes. We performed multivariable logistic regression among men with complete data to assess time trends which adjusting for pertinent factors (e.g., patient age, race/ethnicity, registry, clinical tumor stage, prostate-specific antigen level, Gleason grade, number of positive biopsy cores). RESULTS We identified 76,630 prostate cancer patients treated with radical prostatectomy, of which 44,923 (58.6%) had a lymphadenectomy. Use of lymphadenectomy increased with time from 55.0% in 2010 to 66.0% in 2014 (p<0.001). Among those with a lymphadenectomy, increases were seen with removal of 10+ nodes (24.0% to 30.8%, p<0.001) and 15+ nodes (10.9% to 14.7%, p<0.001). After adjusting for possible confounders, we noted increased prevalence of node-positive disease overall in 2014 vs. 2010 (4.7% vs 2.4%, OR 1.33, 95% 1.15-1.53) (Figure). This persisted among patients receiving lymphadenectomy (4.4% vs 7.1%, OR 1.30, 95% 1.13-1.50), having 10 or more lymph nodes removed (13.8% vs 9.3%, OR 1.31, 95% CI 1.07-1.62), but not those with 15 or more lymph nodes removed (17.2 vs 12.3%, OR 1.25, 95% CI 0.95-1.64) (Figure). CONCLUSIONS The prevalence of node-positive prostate cancer is increasing, independent of changes in performance or extent of lymphadenectomy. Understanding these trends in the context of treatment patterns for high-risk disease (i.e., radiation versus surgery) and prostate cancer screening patterns will be critical moving forward. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e984 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Melissa Taylor More articles by this author Mark Henry More articles by this author Frances Kim More articles by this author Viraj Master More articles by this author Mehrdad Alemozaffar More articles by this author John Pattaras More articles by this author Christopher Filson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...