Extent of lymph node dissection improves survival in prostate cancer patients treated with radical prostatectomy without lymph node invasion

Abstract

More extensive PLND at RP provides improved staging information and consequently is associated with lower CSM in D'Amico intermediate- and high-risk PCa patients without evidence of LNI. Hence, more extensive PLND should be recommended in such individuals.

Reply to the letter to the editor: RE: Preisser F, et al. Extent of lymph node dissection improves survival in prostate cancer patients treated with radical prostatectomy without lymph node invasion. The Prostate. 2018;1‐7

“…We appreciate the interest of Bratt in our study. 1 Indeed, we agree with the possibility that our findings are due to a reclassification bias (Will Rogers phenomenon). The objective of our article was to reexamine the association between pelvic lymph node dissection (PLND) and survival, since no conclusive findings were identified in prospective trials.…”

“…We appreciate the interest of Bratt in our study . Indeed, we agree with the possibility that our findings are due to a reclassification bias (Will Rogers phenomenon).…”

“…The objective of our article was to reexamine the association between pelvic lymph node dissection (PLND) and survival, since no conclusive findings were identified in prospective trials. Although, we do agree about the possibility of a reclassification effect, we also must point out that an equally important possibility exists that the effect that we identified (1.4% survival benefit at 72 months after radical prostatectomy for patients with more than ten removed lymph nodes; Hazard ratio 0.50; P = 0.01) is indeed real and only prospective randomized studies will be able to distinguish between presence or absence of a real effect originating from PLND in this circumstances. Unfortunately, it is unlikely that an adequately powered contemporary study of that type will be completed.…”

RE: Preissner F, et al. extent of lymph node dissection improves survival in prostate cancer patients treated with radical prostatectomy without lymph node invasion. The Prostate. 2018;1–7

“…In January this year, The Prostate published on-line a study based on the Surveillance, Epidemiology, and End results (SEER) database, in which the outcome of 28 147 men who had a radical prostatectomy and PLND, but no evidence of lymph-node (LN) metastasis, was analyzed. 1 The researchers found a slightly lower risk of dying from prostate cancer at 3 years in men who had ≥11 LN identified in the PLND specimens (0.5%) than in men who had <11 LN examined (1.8%). On multivariable analysis, having ≥11 LN identified was associated with higher biopsy Gleason score, higher cT stage, higher preoperative serum prostatespecific antigen levels, more recent year of diagnosis, younger age at diagnosis, and a lower likelihood of dying from prostate cancer.…”

“…In January this year, The Prostate published on‐line a study based on the Surveillance, Epidemiology, and End results (SEER) database, in which the outcome of 28 147 men who had a radical prostatectomy and PLND, but no evidence of lymph‐node (LN) metastasis, was analyzed . The researchers found a slightly lower risk of dying from prostate cancer at 3 years in men who had ≥11 LN identified in the PLND specimens (0.5%) than in men who had <11 LN examined (1.8%).…”