Platinum Priority – Prostate CancerEditorial by Urs E. Studer, Laurence Collette and Richard Sylvester on pp. 762–763 of this issueSurvival Benefit of Radical Prostatectomy in Lymph Node–Positive Patients with Prostate Cancer☆
Introduction
Radical prostatectomy (RP) is commonly accepted as standard therapy for early stage prostate cancer [1], [2], [3], [4]. Although multiple investigations have demonstrated that RP is also a valid option for patients with locally advanced disease [5], [6], RP is often abandoned in cases with positive lymph nodes (LNs). Prostate cancer patients who are LN positive are considered to have a systemic disease with poor prognosis and are often treated with hormonal therapy [7] and/or radiotherapy (RT).
Interestingly, few studies have shown reasonable cancer-specific survival (CSS) of patients with histologically diagnosed pelvic LN metastases who received RP [8], [9], [10], [11], [12]. Furthermore, not all patients with nodal disease are at the same risk of cancer-specific death. Patients with minimal nodal disease have improved survival and may benefit from RP [10], [11].
Today, most surgeons do not routinely perform frozen section analysis of pelvic LNs or abandon RP in the case of an LN-positive finding. The comparison of CSS in LN-positive patients who receive complete RP versus abandoned RP is often compromised by small populations and short follow-up. In this study, we analyzed overall survival (OS) and relative survival (RS) in LN-positive patients with or without RP.
Section snippets
Data collection
The Munich Cancer Registry (MCR) was established in 1978. Initially, the MCR cooperated with the two university hospitals in Munich, Germany, and since 1988, collaborations have extended to all city hospitals and the district of Munich, a region of about 2.3 million inhabitants. The MCR was enlarged to 3.8 million people in 2002 and to 4.5 million in 2007. With an incidence rate of 80 per 100 000 people (world standard), the MCR observes a high population-based incidence of prostate cancer
Results
OS and RS rates for this population-based sample (n = 27 956) are presented in Fig. 1. The 5-yr OS was 76.7% (RS was 93.3%) and 10-yr OS was 55.2% (RS was 84.9%) in this cohort. Fig. 2 shows OS and RS for patients with PLND and complete prostatectomy, according to the number of positive LNs, and demonstrates the prognostic value of LN status.
Table 1 lists the clinical and pathologic characteristics for 1413 patients that composed the current study cohort. The median age was 65.4 yr. Patients with
Discussion
Recent studies have demonstrated that RP is a valid option for patients with locally advanced disease [1], [5], [6]. RP was rarely performed before the 1980s and revolutionized the early 1980s when it was introduced as the accepted form of surgical treatment for localized prostate cancer [13], [14], [15]. When RP was first performed, surgery was commonly abandoned if suspicious pelvic LNs were detected during PLND; the patient was then considered to have systemic disease. This strategy was
Conclusions
Our long-term investigation of node-positive prostate cancer patients treated with PLND and completed or abandoned RP shows significantly improved survival in patients with completed RP. These results suggest that intraoperative frozen section analysis with abandonment of RP may not be justified.
References (30)
- et al.
EAU guidelines on prostate cancer
Eur Urol
(2008) - et al.
Outcome of surgery for clinical unilateral T3a prostate cancer: a single-institution experience
Eur Urol
(2007) - et al.
Early versus delayed endocrine treatment of pN1-3 M0 prostate cancer without local treatment of the primary tumor: results of European Organisation for the Research and Treatment of Cancer 30846—a phase III study
J Urol
(2004) - et al.
Disease progression and survival of patients with positive lymph nodes after radical prostatectomy. Is there a chance of cure?
J Urol
(2003) - et al.
Good outcome for patients with few lymph node metastases after radical retropubic prostatectomy
Eur Urol
(2008) - et al.
Impact of surgical volume on the rate of lymph node metastases in patients undergoing radical prostatectomy and extended pelvic lymph node dissection for clinically localized prostate cancer
Eur Urol
(2008) - et al.
Prognosis of patients with lymph node positive prostate cancer following radical prostatectomy: long-term results
J Urol
(2004) Radical prostatectomy in 2007: oncologic control and preservation of functional integrity
Eur Urol
(2008)- et al.
Anatomical extent of pelvic lymphadenectomy in patients undergoing radical prostatectomy
Eur Urol
(2007) - et al.
Pelvic lymph node dissection in prostate cancer
Eur Urol
(2009)
Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy
Lancet Oncol
Two positive nodes represent a significant cut-off value for cancer-specific survival in patients with node-positive prostate cancer. A new proposal based on a two-institution experience on 703 consecutive N+ patients treated with radical prostatectomy, extended pelvic lymph node dissection and adjuvant therapy
Eur Urol
Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy
JAMA
Long-term follow-up of patients with prostate cancer and nodal metastases treated by pelvic lymphadenectomy and radical prostatectomy: the positive impact of adjuvant radiotherapy
Eur Urol
A critical review of clinical practice guidelines for the management of clinically localized prostate cancer
J Urol
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Jutta Engel and Patrick J. Bastian contributed equally to this paper.