Prognostic and therapeutic significance of pelvic lymph node dissection (PLND) extent in high-grade localized prostate cancer (PCa) patients (pts) treated with prostatectomy.

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e15046 Background: The practice of PLND in all PCa prostatectomy pts remains controversial. Improved prognostic accuracy with PLND is established but the therapeutic benefit is less certain. This analysis was performed to characterize the therapeutic role of PLND exclusively in high- grade PCa pts treated with prostatectomy. Methods: A retrospective review of the Indiana University prostatectomy database that contained clinical, pathologic and outcomes data on all pts undergoing prostatectomy was done. Clinically localized High-grade PCa was defined by a prostatectomy Gleason Grade total score of 8-10, absence of metastatic disease on pre-operative imaging studies. Progression Free Survival (PFS) was defined as time from surgery to post-prostatectomy PSA > 0.2, new radiographic metastases or death. Overall survival (OS) was defined as time from prostatectomy until death. Cox proportional hazards analyses were performed to identify significant prognostic clinical and pathologic patient variables that can predict PFS and OS. Results: Between 1988 and 2005, 103 pts with high-grade PCa who had bilateral PLND were identified. Demographics include: mean age 63.5; mean PSA 13.3; extracapsular extension 68.0%; seminal vesical invasion 42.7%; positive surgical margin 46.6%; stage > T3a 74.8%; mean tumor volume 6.8 ml; positive lymph nodes 13.6%; number of lymph nodes positive range 1-5; median lymph nodes resected 8 (range 2-22); any salvage therapy 55.3%. Median PFS and OS were 18.0 (95% CI 8.7 – 27.3) and 186.0 (95% CI 164.4 – 207.6) months respectively. Cox proportional hazards analyses of the above variables showed no statistically significant associations with PFS or OS. Conclusions: PLND extent failed to predict for PFS or OS in high-grade PCa pts treated with prostatectomy and bilateral PLND. Clinical stage migration leading to low frequency of lymph node positive pts, variations in the number of nodes resected and variations in dissection templates utilized are possible confounders of this analysis. Further studies are warranted in this population with an emphasis on uniform surgical techniques and pathologic analysis. No significant financial relationships to disclose.