Login to Access Video or Poster Abstract: MP64-09
Sources of Funding: none

Introduction

While pelvic lymph node dissection (PLND) offers prognostic value at time of diagnosis for patients with intermediate and high risk prostate cancer, the survival benefit of PLND at radical prostatectomy (RP) is still unclear. In addition, data is limited regarding the value of adding adjuvant radiotherapy in the setting of positive lymph node metastasis._x000D_ Objective: To evaluate associations between oncologic outcomes and nodal count in patients with positive nodes at RP (pN1). Secondary objective is to determine any association between adding adjuvant therapy in patients with lymph node metastasis (pN1+) and improved oncologic outcomes._x000D_

Methods

We analyzed 10,733 men who underwent RP between 1990-2015 at multiple institutions (43 CAPSURE study sites and UCSF Department of Urology), 6,789 of whom had PLND. Median follow up after RP was 56 months. Outcomes after RP were biochemical recurrence-free survival (RFS), bone metastasis-free survival (MFS) and cancer-specific survival (CSS). The associations between adjuvant treatment (none, radiation, ADT), number of nodes dissected, and surgical CAPRA risk score and oncologic outcomes were analyzed using Cox regression models. Analyses were repeated for the subgroup of 254 patients with pN1+.

Results

Among the 6,789 men who had PLND, men with positive nodes had worse pathological staging, cancer grade (Gleason score) and oncological outcomes at 5 years after RP compared to those with pN0 (BCR: 96% vs 80%, MFS: 99% vs 90%, CSS: 99% vs 97%, all log rank p<0.01). Of the 254 men (4%) who had positive lymph node at RP, the median number of LN removed was 12 (interquartile range (IQR) 7-18) and the median number of positive LN was 1 (IQR 1-2). The nodal count as a continuous variable or with cutoff of less or more than 14 did not show any significant association with oncologic outcomes in node positive men. BCR, MFS and CSS for pN1+ patients who received adjuvant therapy in the forms of ADT, XRT or combination did not differ significantly from patients without adjuvant therapy. Main limitation was the small sample size of pN1 patients and retrospective nature of the analysis._x000D_

Conclusions

In a multi-institutional analysis, we found that patients with positive lymph nodes had worse outcomes. In patients with lymph node metastasis, neither nodal count nor adjuvant therapy was associated with better outcomes. _x000D_

Funding

none