You have accessJournal of UrologyProstate Cancer: Staging1 Apr 2011289 ANATOMICAL EXTENT OF LYMPH NODE DISSECTION: IMPACT ON MEN WITH POSITIVE LYMPH NODES AT TIME OF RADICAL PROSTATECTOMY Trinity Bivalacqua, Philip Pierorazio, Ashley Ross, mohamad allaf, H. Ballentine Carter, and Patrick Walsh Trinity BivalacquaTrinity Bivalacqua Baltimore, MD More articles by this author , Philip PierorazioPhilip Pierorazio Baltimore, MD More articles by this author , Ashley RossAshley Ross Baltimore, MD More articles by this author , mohamad allafmohamad allaf Baltimore, MD More articles by this author , H. Ballentine CarterH. Ballentine Carter Baltimore, MD More articles by this author , and Patrick WalshPatrick Walsh Baltimore, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.382AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The therapeutic benefit of a limited and extended pelvic lymph node dissection (PLND) in prostate cancer management is currently under debate. We have previously demonstrated a benefit of extended PLND on biochemical recurrence-free survival (BFS). This study evaluates the influence of the anatomical extent of PLND performed in men with positive LN at time of radical prostatectomy (RP) on LN yield, BFS, metastases free survival (MFS), and prostate cancer specific survival (CSS). METHODS Between 1992 and 2003, two surgeons at one hospital performed 2,279 (PCW) and 1,986 (HBC) RP with PLND, respectively. One surgeon routinely performed an extended PLND (EPLND; superior: bifurcation of common iliac artery; inferior: femoral canal to pelvic side wall; posterior: obturator and internal iliac vessels) while the second surgeon performed a limited PLND (LPLND, differed by posterior extent termination at obturator nerve). Men with positive LN from each cohort were analyzed and compared between the two surgeons using appropriate comparative tests. BFS, MFS (demonstrated by radiography or positive bone scan), and CSS were calculated using the Kaplan-Meier method and log-rank test. RESULTS Of 94 men with positive LN at RP, 73 and 21 men underwent EPLND and LPLND respectively. There was no difference in age, pre-operative PSA, clinical stage, biopsy or pathological Gleason sum among groups. There was no difference in the proportion of men with extraprostatic extension, seminal vesicle invasion and positive surgical margins among groups. The mean follow-up was 10.5 years, 8 (4–16) for LPLND and 12 (1–17) for EPLND (p=0.13). On average, EPLND and LPLND yielded 14.3 (6–29) and 11.4 (4–20) nodes respectively (p=0.02). There was no difference in the number of positive LN (1.66 vs. 1.38, p=0.3) or the proportion of patients with <15% positive LN (28.8% vs. 42.9%, p=0.3) among groups. 5-year BFS was 30.1% and 8.3% for EPLND and LPLND respectively (p=0.05); 10-year MFS was 62.2% vs. 22.2% (p=0.035) and 10-year CSS was 83.6% vs. 52.6% (p=0.2). The magnitude of the difference in BFS and MFS were accentuated in those patients with <15% positive LN (n=30, 31.9%). CONCLUSIONS In a cohort analysis matched for preoperative and pathological prostate cancer characteristics, patients who underwent EPLND had more LN dissected on average and experienced animproved BFS and MFS. Therefore, in addition to affording valuable staging information, an EPLND at RP may provide a therapeutic benefit to patients with LN positive prostate cancer. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e117-e118 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Trinity Bivalacqua Baltimore, MD More articles by this author Philip Pierorazio Baltimore, MD More articles by this author Ashley Ross Baltimore, MD More articles by this author mohamad allaf Baltimore, MD More articles by this author H. Ballentine Carter Baltimore, MD More articles by this author Patrick Walsh Baltimore, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...