Introduction

The aim of this study was to evaluate the impact of the year of surgery on clinical, pathological and oncological outcomes in N+ prostate cancer (PCa) patients who underwent radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND)

Methods

1,653 patients with N+ PCa treated with RP and ePLND at two tertiary care referral centres between 1998 and 2013. Lowess functions were used for graphical representation of the year-by-year trends in clinical, pathological characteristics and use of adjuvant treatments. Linear regression was used to test statistical significance of those temporal trends. Multivariable Cox regression analyses (MVA) were used to assess the relationship between year of surgery and oncological outcomes, namely biochemical recurrence-BCR and clinical recurrence-CR. Covariates consisted of patient age, preoperative PSA, pathological stage (pT2 vs. pT3a vs. ≥pT3b), positive surgical margins-PSM, pathological Gleason score (6 vs. 3+4 vs. 4+3 vs. ≥8) and year of surgery

Results

Overall, 50.6 and 20.1% had BCR and CR, respectively. A significant decrease in the median PSA was observed over time (p=0.02). A similar trend was seen for clinical stage T3 (from 24.8% in 1998 to 6.7% in 2013; p<0.001). Conversely, biopsy Gleason ≥8 dramatically increased from 23% in 1998 to 53.1% in 2013 (p<0.001). We observed a considerable increase in the median number of lymph nodes removed (from 13.4 in 1998 to 20.5 in 2013; p=0.003), associated with an increased rate of patients with ≥3 positive lymph nodes (from 5.6% in 1998 to 30.9% in 2013; p=0.002). Pathological stage remained stable over time (all p?0.8). Conversely, the rate of pathological Gleason 4+3 and ≥8 increased significantly (from 17.6 to 43.1% and from 13.6 to 45.2% in 1998 and 2013, respectively; all p<0.001). The rate of PSM increased between 1998 and 2007, and remained stable thereafter. There was a trend towards lower use of adjuvant therapies (hormonal therapy-HT and radiotherapy with or without HT from 2004 to 2013; p<0.001), with increasing rates of men conservatively managed after RP (p<0.001). At MVA, year of surgery was associated with higher risk of BCR (HR: 1.08; p<0.001) and CR (HR: 1.09; p<0.001)

Conclusions

A trend towards more aggressive disease and worse cancer control was observed in more contemporary N+ PCa patients treated with RP which paralleled a lower rate of utilization of adjuvant therapies. These data should be taken into account when selecting the proper post-operative management of N+ PCa patients

Funding

none