BACKGROUND: We report the 30-year institutional experience of radical prostatectomy (RP) for men with clinically localized prostate cancer (PC) found to have lymph node (LN) metastases at surgery. METHODS: The Johns Hopkins RP Database (1982-2011) was queried for 505 (2.5%) men with node-positive (N1) PC. Survival analysis was completed using the Kaplan-Meier method and proportional hazard regression models. RESULTS: The proportion of men with N1PC was 8.3%, 3.5%, and 1.4% in the pre- (1982-1990), early- (1991-2000), and contemporary-PSA eras (2001-2011), respectively. A trend toward decreasing PSA, less palpable disease but more advanced Gleason sum was noted in the most contemporary era. Median total and positive nodes were 13.2 (1-41) and 1.7 (1-12), respectively. Of 135 patients with a unilateral tumor, 80 (59.3%), 28 (20.7%), and 15 (11.1%) had ipsilateral, contralateral, and bilateral positive LN. 15-year biochemical-recurrence free, metastases-free and cancer-specific survival was 7.1%, 41.5%, and 57.5%, respectively. Predictors of biochemical-recurrence, metastases and death from PC in multivariate analysis included Gleason sum at RP, the number and percent of positive LN; notably total number of LN dissected did not predict outcome. CONCLUSIONS: In this highly-selected RP cohort, men found to have N1PC disease at RP can experience a durable long-term metastases-free and cancer-specific survival. Predictors of survival include Gleason sum, number, and percentage of positive LN. While total number of LN dissected was not predictive, approximately 30% of men with N1PC will have positive LN contralateral to the primary prostatic lesion highlighting the importance of a thorough, bilateral pelvic LN dissection.
BACKGROUND: We report the 30-year institutional experience of radical prostatectomy (RP) for men with clinically localized prostate cancer (PC) found to have lymph node (LN) metastases at surgery. METHODS: The Johns Hopkins RP Database (1982-2011) was queried for 505 (2.5%) men with node-positive (N1) PC. Survival analysis was completed using the Kaplan-Meier method and proportional hazard regression models. RESULTS: The proportion of men with N1PC was 8.3%, 3.5%, and 1.4% in the pre- (1982-1990), early- (1991-2000), and contemporary-PSA eras (2001-2011), respectively. A trend toward decreasing PSA, less palpable disease but more advanced Gleason sum was noted in the most contemporary era. Median total and positive nodes were 13.2 (1-41) and 1.7 (1-12), respectively. Of 135 patients with a unilateral tumor, 80 (59.3%), 28 (20.7%), and 15 (11.1%) had ipsilateral, contralateral, and bilateral positive LN. 15-year biochemical-recurrence free, metastases-free and cancer-specific survival was 7.1%, 41.5%, and 57.5%, respectively. Predictors of biochemical-recurrence, metastases and death from PC in multivariate analysis included Gleason sum at RP, the number and percent of positive LN; notably total number of LN dissected did not predict outcome. CONCLUSIONS: In this highly-selected RP cohort, men found to have N1PC disease at RP can experience a durable long-term metastases-free and cancer-specific survival. Predictors of survival include Gleason sum, number, and percentage of positive LN. While total number of LN dissected was not predictive, approximately 30% of men with N1PC will have positive LN contralateral to the primary prostatic lesion highlighting the importance of a thorough, bilateral pelvic LN dissection.
Authors: Alessandro Conti; Matteo Santoni; Luciano Burattini; Marina Scarpelli; Roberta Mazzucchelli; Andrea B Galosi; Liang Cheng; Antonio Lopez-Beltran; Alberto Briganti; Francesco Montorsi; Rodolfo Montironi Journal: World J Urol Date: 2015-12-22 Impact factor: 4.226
Authors: Baris Turkbey; Harsh K Agarwal; Joanna Shih; Marcelino Bernardo; Yolanda L McKinney; Dagane Daar; Gary L Griffiths; Sandeep Sankineni; Linda Johnson; Kinzya B Grant; Juanita Weaver; Soroush Rais-Bahrami; Mukesh Harisinghani; Paula Jacobs; William Dahut; Maria J Merino; Peter A Pinto; Peter L Choyke Journal: AJR Am J Roentgenol Date: 2015-07 Impact factor: 3.959
Authors: Rana R McKay; Bruce Montgomery; Wanling Xie; Zhenwei Zhang; Glenn J Bubley; David W Lin; Mark A Preston; Quoc-Dien Trinh; Peter Chang; Andrew A Wagner; Elahe A Mostaghel; Philip W Kantoff; Peter S Nelson; Adam S Kibel; Mary-Ellen Taplin Journal: Prostate Cancer Prostatic Dis Date: 2017-12-20 Impact factor: 5.554
Authors: M Moschini; N Fossati; F Abdollah; G Gandaglia; V Cucchiara; P Dell'Oglio; S Luzzago; S F Shariat; F Dehò; A Salonia; F Montorsi; A Briganti Journal: Prostate Cancer Prostatic Dis Date: 2015-11-10 Impact factor: 5.554
Authors: Dae Keun Kim; Kyo Chul Koo; Ali Abdel Raheem; Ki Hong Kim; Byung Ha Chung; Young Deuk Choi; Koon Ho Rha Journal: PLoS One Date: 2016-03-31 Impact factor: 3.240