Clinical Outcome of Patients with Lymph Node-Positive Prostate Cancer following Radical Prostatectomy and Extended Sentinel Lymph Node Dissection

Abstract

Objective: This study sought to evaluate the clinical outcome after extended sentinel lymph node dissection (eSLND) and radical retropubic prostatectomy (RRP) in patients with clinically localized prostate cancer (PCa). Subjects and Methods: From August 2002 until February 2011, a total of 819 patients with clinically localized PCa, confirmed by biopsy, were treated with RRP plus eSLND. Biochemical recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were assessed with Kaplan-Meier curves. Various histopathological parameters were analyzed by univariate and multivariate analysis. Results: The mean follow-up was 5.3 years. Lymph node (LN) metastases occurred in 140 patients. We removed an average of 10.9 LNs via eSLND from patients with pN1 PCa. Postoperatively, 121 pN1 patients temporarily received adjuvant androgen deprivation therapy. The mean survival periods for RFS, RFS after secondary treatment, CSS, and OS were 4.7, 7.0, 8.8, and 8.1 years, respectively. The cancer-specific death rate of the 140 pN1 patients was 13.6%. RFS, CSS, and OS were significantly correlated with pathological margin status, LN density, the total diameter of evident metastases, and membership in the subgroup ‘micrometastases only'. Conclusion: Despite the presence of LN metastases, patients with a low nodal tumor burden demonstrate a remarkable clinical outcome after undergoing eSLND and RRP, thus suggesting a potential curative therapeutic approach.

Clinical Factors Predicting Bilateral Lymph Node Invasion in High-Risk Prostate Cancer

“…The median age was 65 with median PSA levels of 8.4 ng/mL. The median LN(n) was 25 (range [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. Clinical staging assessed the tumor as extracapsular in 12 cases (11.8%) and loco-regional lymph nodes as invaded in 16 patients (15.7%).…”

“…However, there is increasing evidence that the number of metastatic nodes can stratify subpopulations with different prognosis. In high-risk PCA, it has been shown that the lymph node burden is an independent prognostic factor associated with both cancer-specific and overall survival [10,20]. So far, clinical factors predicting the loads of LNI are important for stratifying the high-risk PCA population who is subject to multimodality treatments.…”

Indocyanine green guidance improves the efficiency of extended pelvic lymph node dissection during laparoscopic radical prostatectomy

“…10 Muck et al showed improved survival outcomes in a large series of patients treated with RP and radioactive-guided ePLND when they had a low nodal burden. 24 Grivas et al showed that the integration of ePLND with a ICG-99m Tc-nanocolloid SN biopsy improved BCR-free rates within a median follow-up period of 28 months. 25 As this topic is controversial, several studies pointed out an oncological benefit after a more extensive LND.…”

Prostate-specific antigen associates with extensive lymph node invasion in high-risk prostate cancer

“…In high-risk PCA, it has been shown that the lymph node burden is an independent prognostic factor associated with both cancer-specific and overall survival. 9,22 So far, factors predicting extensive LNI are critical for stratifying high-risk PCA, which needs multimodal sequential treatments. In our study, we have shown that PSA was an independent predictor of the risk of extensive LNI (more than 3 nodes) with a fair discrimination power (area under the curve .792), which represents the main feature differentiating cases with high or low metastatic load.…”