You have accessJournal of UrologyProstate Cancer: Advanced1 Apr 2011640 OUTCOMES OF PATIENTS WITH LYMPH NODE POSITIVE DISEASE FOLLOWING OPEN RADICAL RETROPUBIC PROSTATECTOMY FOR CLINICALLY LOCALIZED PROSTATE CANCER Ryan Dorin, Siamak Daneshmand, Jie Cai, and Gary Lieskovsky Ryan DorinRyan Dorin Los Angeles, CA More articles by this author , Siamak DaneshmandSiamak Daneshmand Los Angeles, CA More articles by this author , Jie CaiJie Cai Los Angeles, CA More articles by this author , and Gary LieskovskyGary Lieskovsky Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1542AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients undergoing radical prostatectomy for clinically localized prostate cancer are occasionally found to have lymph node (LN) metastases on pathological exam. We examined the clinical outcomes of this consecutive cohort of patients who underwent uniform open radical retropubic prostatectomy (RRP) with bilateral pelvic lymph node dissection (PLND) in the PSA era. METHODS We reviewed an IRB approved, prospectively maintained prostate cancer database and identified 2487 patients with clinically organ confined (cT1/cT2) prostate adenocarcinoma who underwent RRP and PLND between July 1988 and June 2008. Patients were excluded if they had undergone preoperative radiation (XRT) or androgen deprivation (ADT), or if their preoperative risk group was indefinable. RESULTS Median follow-up was 7.2 years (range 1–21 years), and a median of 16 LNs were removed per patient. There were 150 patients with LN+ disease (80 with 1 positive LN (+LN), 40 patients with 2 +LNs, and 30 patients with ≥3 +LNs). Estimated 10 year overall survival rates (OS), clinical recurrence free survival (CRFS) and biochemical recurrence free survival (BCRFS) were 86% and 74% (RR 2.2 p<0.001), 97% and 84% (RR 6.8, p<0.001), and 88% and 57% (RR 3.9, p<0.001) for patients with negative LNs and a single positive LN, respectively. Among LN+ patients, there was a significant difference in OS based on number of +LNs, with 75% of patients with ≤2 +LNs and 52% of patients with ≥3 +LNs alive at 10 years (RR 2.3, p= 0.0032), however there were no statistically significant differences in CRFS or BCRFS based on number of +LNs. Patients with ≤2 +LNs were less likely to receive adjuvant therapy, with 32% undergoing ADT and 39% undergoing XRT, while 57% of patients with ≥3 +LNs received ADT and 57% received XRT. There were 49 LN+ patients (33 with 1 +LN, 13 with 2 +LNs, and 3 with ≥3 +LNs) who did not undergo any adjuvant therapy, with 5 and 10 year BCRFS rates of 82% and 59%, and 5 and 10 year CRFS rates of 88% and 80%, respectively. CONCLUSIONS There is a low incidence of unexpected LN metastases in patients with clinically localized prostate cancer undergoing RP. The presence of positive LNs was a significant negative predictor of recurrence and survival, but the number of positive LNs was not, likely resulting from increased use of adjuvant therapies in patients with higher volume LN metastases. RRP with a thorough PLND appears to be curative in a subset of patients with low volume nodal disease. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e259 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Dorin Los Angeles, CA More articles by this author Siamak Daneshmand Los Angeles, CA More articles by this author Jie Cai Los Angeles, CA More articles by this author Gary Lieskovsky Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...