Giancarlo Marra1, Massimo Valerio2, Isabel Heidegger3, Igor Tsaur4, Romain Mathieu5, Francesco Ceci6, Guillaume Ploussard7, Roderick C N van den Bergh8, Alexander Kretschmer9, Constance Thibault10, Piet Ost11, Derya Tilki12, Veeru Kasivisvanathan13, Marco Moschini14, Rafael Sanchez-Salas14, Paolo Gontero15, R Jeffrey Karnes16, Francesco Montorsi17, Giorgio Gandaglia17. 1. Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy. Electronic address: drgiancarlomarra@gmail.com. 2. Department of Urology, CHUV Lausanne, Lausanne, Switzerland. 3. Department of Urology, Medical University Innsbruck, Innsbruck, Austria. 4. Department of Urology and Pediatric Urology, Mainz University Medicine, Mainz, Germany. 5. Department of Urology, CHU Rennes, Rennes, France. 6. Nuclear Medicine, Department of Medical Sciences, University of Turin, Italy. 7. Department of Urology, La Croix du Sud Hospital, Toulouse, France; Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France. 8. Department of Urology, Antonius Hospital, Utrecht, The Netherlands. 9. Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany. 10. Department of Oncology, Hopital Europeen Georges Pompidou, Paris, France. 11. Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium. 12. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 13. Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK. 14. Department of Urology, Institut Mutualiste Montsouris, Paris, France. 15. Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy. 16. Department of Urology, Mayo Clinic, Rochester, MN, USA. 17. Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
Abstract
CONTEXT: Optimal management of prostate cancer (PCa) patients with lymph node invasion at radical prostatectomy and pelvic lymph node dissection still remains unclear. OBJECTIVE: To assess the effectiveness of postoperative treatment strategies for pathologically node-positive PCa patients. The secondary aim was to identify the most relevant prognostic factors to guide the management of pN1 patients. EVIDENCE ACQUISITION: A systematic review was performed in January 2020 using Medline, Embase, and other databases. A total of 5063 articles were screened, and 26 studies including 12 537 men were selected for data synthesis and included in the current review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. EVIDENCE SYNTHESIS: Ten-year biochemical recurrence (BCR)-free, clinical recurrence-free, cancer-specific (CSS), and overall (OS) survival rates ranged from 28% to 56%, 70% to 92%, 72% to 98%, and 60% to 87.6%, respectively. A total of seven, five, and six studies assessed the oncological outcomes of observation, adjuvant radiotherapy (aRT), or adjuvant androgen deprivation therapy (ADT), respectively. Initial observation followed by salvage therapies at the time of recurrence represents a safe option in selected patients with a low disease burden. The use of aRT with or without ADT might improve survival in men with locally advanced disease and a higher number of positive nodes. Risk stratification according to pathological Gleason score, number of positive nodes, pathological stage, and surgical margins status is the key to risk stratification and selection of the optimal postoperative therapy. Limitations of this systematic review are the retrospective design of the studies included and the lack of data on adverse events. CONCLUSIONS: While the majority of men with pN1 disease would experience BCR after surgery, long-term disease-free survival has been reported in selected patients. Management options to improve oncological outcomes include observation versus adjuvant therapies such as aRT and/or ADT. Disease characteristics should be used to select the optimal postoperative management for pN1 PCa patients. PATIENT SUMMARY: Finding node-positive prostate cancer after a radical prostatectomy often leads to high postoperative prostate-specific antigen levels and is overall a poor prognostic factor. However, this does not necessarily translate into poor survival for all men. Management can be tailored to the severity of disease and options include observation, androgen deprivation therapy, and/or radiotherapy.
CONTEXT: Optimal management of prostate cancer (PCa) patients with lymph node invasion at radical prostatectomy and pelvic lymph node dissection still remains unclear. OBJECTIVE: To assess the effectiveness of postoperative treatment strategies for pathologically node-positive PCa patients. The secondary aim was to identify the most relevant prognostic factors to guide the management of pN1patients. EVIDENCE ACQUISITION: A systematic review was performed in January 2020 using Medline, Embase, and other databases. A total of 5063 articles were screened, and 26 studies including 12 537 men were selected for data synthesis and included in the current review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. EVIDENCE SYNTHESIS: Ten-year biochemical recurrence (BCR)-free, clinical recurrence-free, cancer-specific (CSS), and overall (OS) survival rates ranged from 28% to 56%, 70% to 92%, 72% to 98%, and 60% to 87.6%, respectively. A total of seven, five, and six studies assessed the oncological outcomes of observation, adjuvant radiotherapy (aRT), or adjuvant androgen deprivation therapy (ADT), respectively. Initial observation followed by salvage therapies at the time of recurrence represents a safe option in selected patients with a low disease burden. The use of aRT with or without ADT might improve survival in men with locally advanced disease and a higher number of positive nodes. Risk stratification according to pathological Gleason score, number of positive nodes, pathological stage, and surgical margins status is the key to risk stratification and selection of the optimal postoperative therapy. Limitations of this systematic review are the retrospective design of the studies included and the lack of data on adverse events. CONCLUSIONS: While the majority of men with pN1 disease would experience BCR after surgery, long-term disease-free survival has been reported in selected patients. Management options to improve oncological outcomes include observation versus adjuvant therapies such as aRT and/or ADT. Disease characteristics should be used to select the optimal postoperative management for pN1 PCa patients. PATIENT SUMMARY: Finding node-positive prostate cancer after a radical prostatectomy often leads to high postoperative prostate-specific antigen levels and is overall a poor prognostic factor. However, this does not necessarily translate into poor survival for all men. Management can be tailored to the severity of disease and options include observation, androgen deprivation therapy, and/or radiotherapy.
Authors: Fabio Zattoni; Isabel Heidegger; Veeru Kasivisvanathan; Alexander Kretschmer; Giancarlo Marra; Alessandro Magli; Felix Preisser; Derya Tilki; Igor Tsaur; Massimo Valerio; Roderick van den Bergh; Claudia Kesch; Francesco Ceci; Christian Fankhauser; Giorgio Gandaglia Journal: Front Surg Date: 2021-07-09
Authors: Fahad Quhal; Pawel Rajwa; Keiichiro Mori; Ekaterina Laukhtina; Nico C Grossmann; Victor M Schuettfort; Frederik König; Abdulmajeed Aydh; Reza S Motlagh; Satoshi Katayama; Hadi Mostafai; Benjamin Pradere; Giancarlo Marra; Paolo Gontero; Romain Mathieu; Pierre I Karakiewicz; Alberto Briganti; Shahrokh F Shariat; Axel Heidenreich Journal: Prostate Date: 2021-05-31 Impact factor: 4.104