Radical prostatectomy plus extended lymph node dissection for locally advanced prostate cancer: 12-year experience of a single centre

Abstract

Objective To evaluate the functional and oncological outcomes of patients with locally advanced prostate cancer (PCa) treated by hormone therapy combined with extra-fascial laparoscopic radical prostatectomy (LRP) plus extended lymph node dissection (ePLND). Methods From January 2004 to June 2016, a total of 255 PCa cases (pT3-4NxM0) who received LRP plus ePLND were enrolled into our study. The mean age of the patients was 67 (range 44-88) years, and median PSA level was 21.2 (range 0.6-454.0) ng/ml. The patients were divided into earlier group (from January 2004 to December 2011, 160 cases) and later group (from January 2012 to June 2016, 95 cases) according to different treatment periods. The baseline demographics between the two groups were similar. All patients routinely received adjuvant hormone therapy (AHT) postoperatively. The patients in the later group underwent collapsin response mediator protein 4 (CRMP4) methylation study on the prostatic biopsy preoperatively. Those with a CRMP4 methylation level >15% or rectum/bladder neck invasion, were treated by neoadjuvant hormone therapy (NHT) for 3-6 months. Positive surgical margin (PSM), progression-free survival (PFS), cancer-specific survival (CSS), overall survival (OS) and postoperative continence rates between the two groups were analyzed and compared. Results The mean operative time of the earlier and later group were (239±65) min and (203±51) min, mean blood loss were (109±65) ml and (96±44) ml, mean dissected nodes were (19±5) and (21±7), respectively (all P>0.05). The total PSM rate was 19.2%, and PSM rates of the two groups were 23.1% and 12.6% (P=0.04). All the 255 cases received AHT and 25 cases in the later group underwent NHT. The median follow-up time was 73 months (range 10-152 months). The total 5-year PFS, CSS and OS rates were 77.7%, 94.3% and 87.1%, respectively, and the rates between groups were 73.8% vs. 86.1% (P=0.03), 93.1% vs. 98.6% (P=0.07), and 85.0% vs. 92.8% (P=0.11), respectively. The 1-year postoperative continence rates were 91.9% vs. 97.9% (P=0.09). Conclusions Hormone therapy combined with LRP plus ePLND represents an oncological and functional effective option in patients with locally advanced PCa, and improved PFS might be acquired by preoperative tumor staging. Key words: Prostatic neoplasms; Locally advanced; Radical prostatectomy; Hormone therapy; Pelvic lymph node dissection