Abstract
Background
This study aimed to investigate the role of radical prostatectomy (RP) among clinical nodal metastasis prostate cancer and whether histological confirmation of lymph node metastasis through surgery can help with treatment.
Patients and Methods
After excluding patients with distant metastatic prostate cancer or neoadjuvant androgen deprivation therapy, 42 patients with clinical nodal metastasis who underwent RP at our institution were included in the study. We classified them as having or not having pathological lymph node metastasis. Clinicopathologic data were analyzed in this retrospective chart review. Kaplan–Meier analysis was used to calculate the estimated castration-resistant prostate cancer (CRPC)-free survival, biochemical recurrence (BCR)-free survival, and cancer-specific survival (CSS).
Results
There is no significant difference in age, presence of diabetes mellitus, hypertension, BCR time, CRPC time, overall survival, salvage RT rate, and initial prostate-specific antigen level between the two groups. However, there is a significant difference in the pathology N1 group in terms of pathological T stage, pathologic Gleason score, BCR rate, CRPC rate, and CSS. A multivariate Cox proportional hazard regression analysis was used to identify predictors of CRPC-free survival. Patients with pathological lymph node metastasis had a shorter CRPC-free survival [hazard ratio (HR) 4.87; 95% confidence interval (CI) 1.25–19.00, p = 0.02].
Conclusion
Radical prostatectomy can confirm lymph node metastasis. Although pathologic diagnosis has no effect on time to BCR and CPRC, because it affects BCR rate, CRPC rate, and CSS, an accurate pathological diagnosis obtained through surgery is beneficial in the treatment of clinical lymph node metastasis prostate cancer.
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References
American Cancer Society. About Prostate Cancer 2021 [Available from: https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html.
World Cancer Research Fund International. Prostate cancer statistics 2020 [Available from: https://www.wcrf.org/cancer-trends/prostate-cancer-statistics/.
Seisen T, Vetterlein MW, Karabon P, **dal T, Sood A, Nocera L, et al. Efficacy of local treatment in prostate cancer patients with clinically pelvic lymph node-positive disease at initial diagnosis. Eur Urol. 2018;73(3):452–61.
Datta K, Muders M, Zhang H, Tindall DJ. Mechanism of lymph node metastasis in prostate cancer. Future Oncol. 2010;6(5):823–36.
Cheng L, Zincke H, Blute ML, Bergstralh EJ, Scherer B, Bostwick DG. Risk of prostate carcinoma death in patients with lymph node metastasis. Cancer. 2001;91(1):66–73.
Deng FM, Mendrinos SE, Das K, Melamed J. Periprostatic lymph node metastasis in prostate cancer and its clinical significance. Histopathology. 2012;60(6):1004–8.
Kazzazi A, Djavan B. Current status of pelvic lymph node dissection in prostate cancer: the New York PLND nomogram. Can J Urol. 2011;18(2):5585–91.
Chenam A, Parihar JS, Ruel N, Pal S, Avila Y, Yamzon J, et al. Lymph node-positive prostate cancer after robotic prostatectomy and extended pelvic lymphadenectomy. J Robot Surg. 2018;12(3):425–31.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Prostate Cancer Version 1.2023 2022 [Available from: https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf.
Mandel P, Steuber T, Graefen M. Radical prostatectomy in oligometastatic prostate cancer. Curr Opin Urol. 2017;27(6):572–9.
Jenjitranant P, Touijer KA. Role of surgery in oligometastatic prostate cancer. Prostate Int. 2019;7(4):125–30.
Chipollini JJ, Pow-Sang JM. Lymph node positive prostate cancer: the evolving role of adjuvant therapy. Transl Cancer Res. 2018;7:S94–5.
Motterle G, Ahmed ME, Andrews JR, Karnes RJ. The role of radical prostatectomy and lymph node dissection in clinically node positive patients. Front Oncol. 2019;9:1395.
Chierigo F, Borghesi M, Würnschimmel C, Flammia RS, Horlemann B, Sorce G, et al. Survival after radical prostatectomy versus radiation therapy in clinical node-positive prostate cancer. Prostate. 2022;82(6):740–50.
Sundi D, Svatek RS, Nielsen ME, Schoenberg MP, Bivalacqua TJ. Extent of pelvic lymph node dissection during radical cystectomy: is bigger better? Rev Urol. 2014;16(4):159–66.
Zarzour JG, Galgano S, McConathy J, Thomas JV, Rais-Bahrami S. Lymph node imaging in initial staging of prostate cancer: an overview and update. World J Radiol. 2017;9(10):389–99.
Amling CL, Bergstralh EJ, Blute ML, Slezak JM, Zincke H. Defining prostate specific antigen progression after radical prostatectomy: what is the most appropriate cut point? J Urol. 2001;165(4):1146–51.
Scher HI, Halabi S, Tannock I, Morris M, Sternberg CN, Carducci MA, et al. Design and end points of clinical trials for patients with progressive prostate cancer and castrate levels of testosterone: recommendations of the prostate cancer clinical trials working group. J Clin Oncol. 2008;26(7):1148–59.
Ventimiglia E, Seisen T, Abdollah F, Briganti A, Fonteyne V, James N, et al. A systematic review of the role of definitive local treatment in patients with clinically lymph node-positive prostate cancer. Eur Urol Oncol. 2019;2(3):294–301.
Lin CC, Gray PJ, Jemal A, Efstathiou JA. Androgen deprivation with or without radiation therapy for clinically node-positive prostate cancer. J Natl Cancer Inst. 2015;107(7):119.
Petersen LJ, Zacho HD. PSMA PET for primary lymph node staging of intermediate and high-risk prostate cancer: an expedited systematic review. Cancer Imaging. 2020;20(1):10.
Hope TA, Eiber M, Armstrong WR, Juarez R, Murthy V, Lawhn-Heath C, et al. Diagnostic accuracy of 68Ga-PSMA-11 PET for pelvic nodal metastasis detection prior to radical prostatectomy and pelvic lymph node dissection: a multicenter prospective phase 3 imaging trial. JAMA Oncol. 2021;7(11):1635–42.
Pollack A, Horwitz EM, Movsas B. Treatment of prostate cancer with regional lymph node (N1) metastasis. Semin Radiat Oncol. 2003;13(2):121–9.
Öbek C, Doğanca T, Demirci E, Ocak M, Kural AR, Yıldırım A, et al. The accuracy of 68Ga-PSMA PET/CT in primary lymph node staging in high-risk prostate cancer. Eur J Nucl Med Mol Imaging. 2017;44(11):1806–12.
Jegadeesh N, Liu Y, Zhang C, Zhong J, Cassidy RJ, Gillespie T, et al. The role of adjuvant radiotherapy in pathologically lymph node-positive prostate cancer. Cancer. 2017;123(3):512–20.
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Study conception and design: BL, DK; data acquisition: DK; data analysis and interpretation: DK, DY; manuscript drafting: DK, IGJ; critical manuscript revisions: JS, JHH, HA; supervision: BL.
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Kim, D., Lim, B., Suh, J. et al. Clinical Significance of Radical Prostatectomy in Clinical Lymph Node Metastasis in Prostate Cancer. Ann Surg Oncol 30, 7903–7909 (2023). https://doi.org/10.1245/s10434-023-14137-4
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DOI: https://doi.org/10.1245/s10434-023-14137-4