Login to Access Video or Poster Abstract: MP20-17
Sources of Funding: none

Introduction

With the professional guidelines pulling back on the utility and frequency of prostate cancer screening, there is concern there will be a stage shift with an increase in lymph node metastases. Against this backdrop, the objective of our contemporary, population-based study was to examine outcomes associated with pelvic lymph node metastases.

Methods

We identified 161,079 radical prostatectomies during 2004-2014 using the Surveillance, Epidemiology, and End Results (SEER). Propensity score matching was used to adjust for confounding. Time to event analysis were used to compare all-cause mortality as well prostate cancer-specific mortality for those with (pN+) and without (pN-) pelvic lymph node metastases.

Results

From the total, we identified 3,697 radical prostatectomy pN+ (2.3%). Older age, higher grade and higher tumor stage were associated with pN+ (p<0.01, respectively). After propensity matching, pN+ disease was associated with higher all-cause mortality (28.5 vs 10.8 deaths per 1,000 person years, p<0.001) as well as higher prostate cancer-specific mortality (17.5 vs 3.5 deaths per 1,000 person years, p<0.01), with a median follow-up of 3.6 years (Figure 1). A higher number of positive lymph nodes was strongly associated with worse overall survival and prostate cancer-specific survival (Figure 2).

Conclusions

In light of our SEER studies demonstrating a recent increase in prostate cancer metastatic disease, it is worth noting that men with pN+ have significantly poorer outcomes. The effect on mortality was further increased by the number of positive lymph nodes. The outcomes from our study may guide men concerning adjuvant therapies and clinical trials.

Funding

none