Disease Progression and Survival of Patients With Positive Lymph Nodes After Radical Prostatectomy. Is there a Chance of Cure?

Bader, Pia; Burkhard, Fiona C.; Markwalder, Regula; Studer, Urs E.

doi:10.1097/01.ju.0000049032.38743.c7

Cited by 401 publications

(304 citation statements)

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“…However, it has been long understood that degree of LN involvement has a significant role in outcome. Whether microscopic versus gross involvement [4,5], LN tumor volume [6], presence of extracapsular extension [7] or described by ratio [5,8,9], less LN involvement contributes to longer survival than more involvement.…”

Section: Introductionmentioning

confidence: 99%

Stratifying prostate cancer patients by relative lymph node involvement: population‐ and modeling‐based study

2016

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It is estimated that about 10% of new prostate cancer (PCa) cases are lymph node‐positive (LN+). We have previously discussed the role of the inflection point (IP) of an inverse Gompertzian survival curve as a surrogate for disease incurability. In this study, we aimed to stratify curability of different patient cohorts with pathologically positive lymph nodes through modeling survival curves by different percentages of LN involvement (%LN+) postoperatively and calculating associated IPs. From the Surveillance, Epidemiology, and End Results (SEER) database, we selected LN+ PCa patients undergoing radical prostatectomy. Modeling of relative survival curves using inverse Gompertzian kinetics for increasing value of maximal %LN+ involvement allowed stratification of cohort into groups with <10%, 10–40%, and greater or equal to 40% of LN+ out of all LNs sampled. Data were retrieved for 5903 patients. For the entire cohort, relative survival was 96%, 87%, and 76% at 5, 10, and 15 years, respectively. For %LN +, <10% the IP was about 27 years postoperatively. Patients with 10–40% LN+ had an IP at about 10 years; for those with more than 40% LN+, the IP was 7 years. A 10‐year relative survival decreases from 97% for <10% LN+ to 71% for more than 40% LN+. While better therapies for LN + PCa are badly needed, this patient cadre is not homogenous and should be stratified by %LN+ in future clinical trials.

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Section: Introductionmentioning

confidence: 99%

Stratifying prostate cancer patients by relative lymph node involvement: population‐ and modeling‐based study

2016

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“…Bader et al reported a 5 year CSS of 90% if only one lymph node was invaded. 43 Schumacher et al showed a 10 year cancer specific survival (CSS) of 78,6% if maximum 2 lymph nodes were involved. 44 Patients with minimal LNI might thus not be incurable and one might question whether 9 adding adjuvant whole pelvic EBRT to the postoperative setting might further improve local control and might prevent metastatic disease and PC death.…”

Section: Whole Pelvis Irradiation For Lymph Node Metastasized Pcmentioning

confidence: 99%

Developments in External Beam Radiotherapy for Prostate Cancer

Lumen

Ost

Praet

et al. 2013

Urology

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“…In addition, a therapeutic and cancer-specific survival benefit may occur after PLND. [1][2][3][4] With the rise of the prostate-specific antigen (PSA) era, a downward stage migration resulting from the earlier detection of prostate cancer has led to a decreased incidence of positive LNs. [20][21][22] To determine who should undergo a PLND, the benefits must be weighed against the associated comorbidities and applied to those who are at risk of metastatic disease.…”

Section: Who Should Undergo Plnd?mentioning

confidence: 99%

“…Similarly, in another small series, 42 patients with low tumor bulk and one positive LN had survival rates comparable to those matched controls at 5-year follow-up. Recently, Bader et al 1 demonstrated the probability of PSA relapse, symptomatic progression and tumor-related death increased with each additional positive LN removed. They performed a careful extended PLND and RRP on 367 men with clinically organ-confined prostate cancer; 92 (25%) had positive LNs.…”

Section: Are There Therapeutic Benefits To Performing Plnd?mentioning

confidence: 99%

“…Some believe that PLND is therapeutic and promotes a cancer-specific survival benefit. [1][2][3][4] This review aims to critically analyze: (1) the anatomy of the prostate gland's lymphatic drainage, (2) the anatomic boundaries of PLND and which dissection may be superior, (3) who should undergo a PLND during prostatectomy, (4) the potential therapeutic benefits of performing PLND and (5) the complications of PLND. …”

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Pelvic lymphadenectomy in prostate cancer

Breyer

Greene

Dall′Era

et al. 2008

Prostate Cancer Prostatic Dis

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This review analyzes the anatomy of the prostate gland's lymphatic drainage, the optimal anatomic extend of pelvic lymph node dissection (PLND) and which dissection may be superior, who should undergo a PLND during prostatectomy, and its potential therapeutic benefits and complications. The prostate gland's lymphatic drainage can be variable, but frequently metastatic disease is found in the internal iliac chain. We conclude that the extended PLND yields the most lymph nodes and therefore may be superior. Some have demonstrated an unproven survival benefit after performing an extended PLND, possibly from removal of occult disease or from more accurate staging.Prostate Cancer and Prostatic Diseases (2008) 11, 320-324; doi:10.1038/pcan.2008 published online 20 May 2008 Keywords: pelvic lymph node dissection; lymph nodes; anatomy; radical retropubic prostatectomyThe role of pelvic lymph node dissection (PLND) during radical prostatectomy has generated considerable debate. The central role of a PLND is to determine the locoregional extent of cancer, and to help evaluate the need for adjuvant therapy and the risk of progression and recurrence. Some believe that PLND is therapeutic and promotes a cancer-specific survival benefit. [1][2][3][4] This review aims to critically analyze: (1) the anatomy of the prostate gland's lymphatic drainage, (2) the anatomic boundaries of PLND and which dissection may be superior, (3) who should undergo a PLND during prostatectomy, (4) the potential therapeutic benefits of performing PLND and (5) the complications of PLND. PLND anatomically definedAnatomic studies have been performed to define the periprostatic subcapsular lymphatic network that drains the prostate. 5,6 The network is composed of the ascending, lateral and posterior groups. The ascending ducts drain into the external iliac lymph nodes, the lateral ducts into the hypogastric node chain, and the posterior ducts draining from the caudal prostate to the subaortic lymph nodes of the sacral promontory. 5,6 Weingartner et al. 7 performed extensive PLND on cadavers. A mean lymph node (LN) yield of 20 was found and the authors suggested that this number serve as a guideline for sufficient PLDN. Interestingly, they analyzed prostate cancer patients's LNs and found that they were relatively enlarged, whether they contained cancer or not, compared to non-cancer cadavers.Three approaches to the PLND have been described: limited, standard and extended. 8,9 (Table 1, Figure 1) The exact nomenclature and surgical boundaries of PLND vary between institutions and lack standardization. International consensus on anatomic boundaries and use of descriptive terminology is needed. 9 Standardization would promote uniformity of practice and improve the comparison of future studies on PLND in prostate cancer.What is the optimal anatomic extend of PLND?Considerable debate exists over the appropriate boundaries of PLND during radical retropubic prostatectomy (RRP). Proponents of the extended PLND argue that it significantly increases yield of ...

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Disease Progression and Survival of Patients With Positive Lymph Nodes After Radical Prostatectomy. Is there a Chance of Cure?

Cited by 401 publications

References 24 publications

Stratifying prostate cancer patients by relative lymph node involvement: population‐ and modeling‐based study

Stratifying prostate cancer patients by relative lymph node involvement: population‐ and modeling‐based study

Developments in External Beam Radiotherapy for Prostate Cancer

Pelvic lymphadenectomy in prostate cancer

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