Contemporary Patterns of Care and Outcomes of Men Found to Have Lymph Node Metastases at the Time of Radical Prostatectomy

Abstract

Purpose A thorough understanding of the natural history and consensus regarding the optimal management of pathologic lymph node-positive (pN1) prostate cancer are lacking. Our objective was to describe patterns of care and outcomes of a contemporary cohort of men with pN1 prostate cancer. Materials and Methods The National Cancer Data Base (NCDB) was used to identify 7,791 men who were found to have LN metastases at the time of radical prostatectomy (RP). Multinomial logistic regression and Cox proportional hazards regression were used to identify patient, tumor and facility characteristics associated with choice of post-RP management strategy and overall survival (OS), respectively. Results Sixty-three percent of men were initially managed with observation, 20% with ADT alone, 5% with RT alone and 13% with ADT and RT. Younger age, lower comorbidity burden, higher grade and stage and the presence of positive surgical margins were associated with a higher likelihood of receiving combination therapy. Grade group 4-5 disease, pT3b-T4 disease, positive surgical margins and a higher number of positive LN were independent predictors of worse OS, with adjusted ten-year OS probabilities decreasing from 84% to 32% with the presence of an increasing number of adverse prognostic factors. Treatment with combined ADT and RT was associated with better OS (multivariable HR 0.69 for combination therapy vs. observation, 95% CI 0.52, 0.92, p=0.010). Conclusions Patient and tumor characteristics are associated with both choice of post-RP management strategy and survival in men with pN1 prostate cancer. Multimodal therapy may be of benefit in this patient population.

Management of Patients with Node-positive Prostate Cancer at Radical Prostatectomy and Pelvic Lymph Node Dissection: A Systematic Review

“…Moreover, although a RCT specifically designed in the pN1 setting demonstrated that immediate androgen deprivation therapy (aADT) might be associated with a survival benefit, its results might not be generalizable to contemporary pN1 patients due to the inclusion of patients diagnosed in the pre-PSA era with high nodal burden [4,5]. Finally, despite the fact that all patients with LNI are categorized as pN1 regardless of the number and location of positive nodes according to the TNM classification, the long-term prognosis of this group is highly heterogeneous and varies significantly according to disease characteristics [6][7][8][9][10][11][12][13].…”

Current Status and Future Perspective on the Management of Lymph Node-Positive Prostate Cancer after Radical Prostatectomy

“…Moreover, they have recently reported a higher CSS with adjuvant RT than with salvage RT [ 30 ]. Consistently, expectant management for pN1 was associated with inferior survival than adjuvant treatment including RT in retrospective case series and database studies [ 24 , 27 , 28 , 31 ]. In contrast, the RADICALS-RT trial that enrolled mainly pN0 or pNx in addition to pN1 patients has recently reported a comparable BCR rate between adjuvant RT and salvage RT [ 32 ].…”

Features and management of men with pN1 cM0 prostate cancer after radical prostatectomy and lymphadenectomy: a systematic review of population-based evidence

“…Supplementary Material 1, http://links.lww.com/ COU/A36 presents a multivariate analysis of the effect of different management strategies on overall and/or cancer-specific survival. aADT was not found to have any benefit in overall survival [10,11,14,15] nor in cancer-specific mortality [11]) compared to observation. Similarly, aRT alone had no survival advantage over observation [14,15].…”