Prognosis of Patients With Lymph Node Positive Prostate Cancer Following Radical Prostatectomy: Long-Term Results

Daneshmand, Siamak; Quek, Marcus L.; Stein, John P.; Lieskovsky, Gary; Cai, Jie; Pinski, Jacek; Skinner, Eila C.; Skinner, Donald G.

doi:10.1097/01.ju.0000143448.04161.cc

Cited by 285 publications

(206 citation statements)

References 17 publications

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“…Overall, clinical recurrence-free and BCR-free survival at 10 years was an impressive 74, 69, and 40%, respectively. 18 Other studies have demonstrated similar outcomes suggesting that PLND may remove all metastatic disease and allow good long-term progressionfree survival PFS in select cases. 19,20 Joslyn and Konety 21 demonstrated in a Surveillence Epidemiology and End Results database study that patients who underwent PLND with excision of at least 4 LN had improved CSS compared with patients who did not undergo PLND.…”

Section: Ongoing Controversies In Plndmentioning

confidence: 80%

“…Some advocate extending the dissection up to the ureteric crossing or beyond. 18 Larger templates have the advantage of including more of the potential landing sites for the metastatic disease at the cost of additional time to perform the procedure and increased morbidity. 24 Heidenreich et al performed an extended template PLND (ePLND) on 103 consecutive patients and compared this with 100 patients who underwent standard PLND.…”

Section: Anatomic Extent Of Lymph Node Dissectionmentioning

confidence: 99%

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Lymph node dissection during robot-assisted radical prostatectomy: where do we stand?

Silberstein

Derweesh

Kane

2009

Prostate Cancer Prostatic Dis

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Since the initial report of robot-assisted laparoscopic prostatectomy (RALP) in 2001, the technique has gained rapid acceptance and utilization. When compared with more traditional forms of surgical intervention, there is still much debate with respect to cost, and impact on potency and continence. Less often is the focus on oncologic outcomes. Pelvic lymph node dissection (PLND) at the time of prostatectomy is an important part of the surgical intervention for prostate cancer and is currently underreported during robotic procedures. Herein, we review the current controversies on the value and extent of PLND and the status of emerging data regarding robot-assisted PLND. IntroductionRadical prostatectomy has undergone an evolution in technique over many decades with older procedures being largely replaced by newer ones due to perceived superiority of oncologic outcomes or diminution of operative morbidity. [1][2][3] In the United States, da Vinci robot-assisted laparoscopic prostatectomy (RALP) has gained rapid popularity because of the facility with which it allows laparoscopic skills to be transferred to even non-laparoscopically trained surgeons. 4 Thus, the benefits of laparoscopy, enhanced optical magnification, decreased blood loss, and minimal incisions can be obtained without prolonged learning curves. Any time a new technique is introduced, it must be compared with current methods to ascertain at least equivalent outcomes, in addition to assessment of benefits, and limitations. To this end, there have been recent publications from the centers of excellence attempting to compare RALP to radical retropubic and pure laparoscopic techniques. 5,6 However, there has been a paucity of literature addressing pelvic lymph node dissection (PLND) at the time of RALP. This is not the case with all urologic robot-assisted procedures; recent literature on robot-assisted radical cystectomy has specifically focused on feasibility and adequacy of robot-assisted PLND. 7 Thus, the lack of literature on robot-assisted PLND at RALP may reflect that PLND at the time of prostatectomy performed through open technique (or otherwise) is a controversial topic. Important questions remain regarding patient selection, potential benefit and anatomic extent of the dissection, nodal yield, and complication rates. We will review these controversies and the state of the literature regarding RALP PLND in this context. Ongoing controversies in PLNDIn the United States, prostate cancer is the most commonly diagnosed noncutaneous cancer and the second-leading cause of cancer death among men. In 2008, 186 320 men were diagnosed with, and 28 660 men died of, prostate cancer in the United States. 8 The advent of prostate-specific antigen (PSA) screening has led to a profound stage migration such that men diagnosed in the PSA era are younger and have lower clinical and pathologic stage and lower mortality rates, and when treated they have improved margin-free status and biochemical progression-free survival and decreased extracapsular extension a...

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Section: Ongoing Controversies In Plndmentioning

confidence: 80%

Section: Anatomic Extent Of Lymph Node Dissectionmentioning

confidence: 99%

Lymph node dissection during robot-assisted radical prostatectomy: where do we stand?

Silberstein

Derweesh

Kane

2009

Prostate Cancer Prostatic Dis

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“…They also demonstrated that radical prostatectomy patients with a single nodal metastasis were at a threefold higher risk for systemic progression and fourfold higher risk for prostate cancer death, but in comparison, those with two or more lymph node metastases were twice as likely to experience systemic progression as well as prostate cancer death. Similarly, Skinner's group confirmed a 10-year recurrence-free survival rate following a radical prostatectomy of 70%-73% in patients with one or two lymph node metastases, but only a 49% rate in those with five or more involved nodes [63]. In addition, when pathological specimens were reviewed, Griebling et al [64] found that the 5-year overall survival rate for patients with extracapsular nodal extension was 55%, compared with 71% for those with histologically confined prostatic nodal metastases.…”

Section: Prostate Cancermentioning

confidence: 81%

“…In addition, a Ͻ15% density in patients conferred a 5-year PSA progression-free survival rate of 43% following an extended PLND, compared with only 10% after a limited PLND. Daneshmand et al [63] also identified that patients with a Յ20% lymph node density had a 72% 10-year recurrence-free survival rate, compared with a 47% 10-year survival rate for those with Ͼ20% density.…”

Section: Prostate Cancermentioning

confidence: 99%

Indications, Extent, and Benefits of Pelvic Lymph Node Dissection for Patients with Bladder and Prostate Cancer

2009

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Target audience: Physicians who wish to advance their current knowledge of clinical cancer medicine in genitourinary cancer. LEARNING OBJECTIVES1. Evaluate all patients undergoing radical pelvic surgery to determine whether they should have pelvic lymph node dissection.2. Determine to what extent a pelvic lymph node dissection should be performed and analyze the risks involved.3. Based on best practices, assess whether pelvic lymph node dissection is beneficial for staging and prognosis.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTThe role of pelvic lymph node dissection (PLND) in both bladder and prostate cancer has recently been generating renewed interest. In an attempt to avoid PLND, both nomograms and imaging studies have been evaluated; however, so far they have shown limited success because of inadequate accuracy in staging patients. The three primary objectives of this review are: to define patients in whom PLND should be performed, to define the extent and consequences of the template for PLND, and to identify the staging and prognostic benefits seen with PLND in bladder and prostate cancer. Based on the findings from this review, we conclude that PLND for bladder cancer patients is undoubtedly beneficial, whereas it is less so for prostate cancer patients, in whom a selection strategy should be employed. PLND, in particular with an extended template, seems to provide superior accuracy for postoperative staging than the presently available imaging studies and may be pivotal when considering adjuvant therapies. Furthermore, it has an impact on survival in high-risk patients, and potentially more so in low-risk cancer patients with occult metastases.

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“…This issue is controversial for prostate cancer management given the lack of prospective data and ambiguous retrospective studies 1 and is illustrated in the variation in our clinical practice guidelines (Table 1). [2][3][4][5] Coincident with the decrease of lymph node involvement (LNI) in most prostatectomy series 6,7 there has been remarkable decline in pelvic lymph node dissection (PLND) for low-risk disease, 8 although this trend may be less apparent in Canada. 9 A risk-adapted approach to PLND remains controversial; it has been suggested that other complicating elements are involved in its decline, including changes in surgical approach as well as reimbursement issues.…”

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confidence: 99%

Why all prostate cancer surgery should include an adequate lymph node dissection

Siemens

2013

CUAJ

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Prognosis of Patients With Lymph Node Positive Prostate Cancer Following Radical Prostatectomy: Long-Term Results

Abstract: Local tumor bulk and the number/percent of involved lymph nodes significantly affect disease progression and the survival rate. Radical prostatectomy may offer long-term survival in patients who have limited tumor bulk and nodal involvement.

Cited by 285 publications

References 17 publications

Lymph node dissection during robot-assisted radical prostatectomy: where do we stand?

Lymph node dissection during robot-assisted radical prostatectomy: where do we stand?

Indications, Extent, and Benefits of Pelvic Lymph Node Dissection for Patients with Bladder and Prostate Cancer

Why all prostate cancer surgery should include an adequate lymph node dissection

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