PD63-09 ONCOLOGICAL OUTCOME OF LOCALIZED, LYMPH NODE-POSITIVE PROSTATE CARCINOMA AFTER RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy V (PD63)1 Apr 2020PD63-09 ONCOLOGICAL OUTCOME OF LOCALIZED, LYMPH NODE-POSITIVE PROSTATE CARCINOMA AFTER RADICAL PROSTATECTOMY Lara Franziska Stolzenbach*, Philipp Mandel, Florian Loecherbach, Uwe Michl, Hans Heinzer, Markus Graefen, and Thomas Steuber Lara Franziska Stolzenbach*Lara Franziska Stolzenbach* More articles by this author , Philipp MandelPhilipp Mandel More articles by this author , Florian LoecherbachFlorian Loecherbach More articles by this author , Uwe MichlUwe Michl More articles by this author , Hans HeinzerHans Heinzer More articles by this author , Markus GraefenMarkus Graefen More articles by this author , and Thomas SteuberThomas Steuber More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000980.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pathologically confirmed regional lymph node metastases represent a major prognostic factor in patients with prostate cancer (PCa) who undergo radical prostatectomy (RP). Rarely, positive lymph nodes (pN1) are also observed in localized (pT2) PCa after RP. The aim of this study was to investigate the oncological outcomes after RP in patients with pT2 pN1 cM0 PCa. METHODS: Within a single institution database (1992-2018), we retrospectively analyzed 28,647 PCa patients who underwent radical prostatectomy between 1992 and 2018. Kaplan-Meier plots were used to depict biochemical recurrence (BCR)-free survival and multivariable Cox regression models were used to test for predictors of BCR, within patients who harboured pT2 N1 M0 PCa. RESULTS: Of 28,647 patients, 241 (0.8%) harboured pT2 N1 M0 PCa at the final pathological evaluation. This represents 1.3% of all pT2 PCa patients (n=18,369) and 8.9% of all pN1 (n=2,701) patients. Within the pT2 N1 M0 patients, the number of positive lymph nodes revealed as following: 175 (72.6%) patients had 1 positive lymph node, 41 (17.0%) patients had 2 positive lymph nodes, 25 (10.4%) patients had ³3 positive lymph nodes. The median follow-up of all patients was 36.3 months. 20 (8.3%) and 56 (23.2%) pT2 N1 M0 PCa patients received either adjuvant (aRT) or salvage radiation (sRT), respectively. 3 and 16 patients received additionally to the RT adjuvant antiandrogen therapy (ADT) or salvage ADT. 3 (1.2%) and 15 (6.2%) pT2 N1 M0 PCa patients were only treated with either adjuvant or salvage ADT. During the follow-up, 4 (1.6%) individuals died of PCA and 16 developed metastases, which resulted in a 5-year MFS of 92.5%. Median BCR-free survival was 36.3 months and 5-year BCR-free survival rate was of 54.7 %, within the entire pT2 N1 M0 PCa cohort. Of these, patients who received only aRT showed significantly higher BCR-free rates compared to patients who did not received any treatment (5-year BCR free survival: 94.1% vs. 80.5%; p=0.001). In the multivariable analyses adjusted for preoperative PSA value, two or more positive lymph nodes (HR 1.97, p=0.02 for 2 vs.1 and HR 4.41, p<0.01 for >=3 vs. 1), and Gleason grading group IV-V (HR 2.04, p=0.03) were associated with a higher risk of BCR. Conversely, use of aRT (HR 0.27, p=0.04) was associated with a lower risk of BCR. CONCLUSIONS: Pathologically confirmed positive lymph node disease is a rare finding within patients with pT2 PCa. 5-year BCR-free survival was 54.7% in pT2 pN1 patients. However, two or more positive lymph nodes, a Gleason grade group IV-V represent risk factors for BCR. In consequence, adjuvant radiotherapy should be recommended in patients with these clinical-pathological characteristics. Source of Funding: There was no external financial support for this study. The authors declare that they have no conflict of interest. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1296-e1296 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lara Franziska Stolzenbach* More articles by this author Philipp Mandel More articles by this author Florian Loecherbach More articles by this author Uwe Michl More articles by this author Hans Heinzer More articles by this author Markus Graefen More articles by this author Thomas Steuber More articles by this author Expand All Advertisement PDF downloadLoading ...