Long-term follow-up of patients with prostate cancer and nodal metastases treated by pelvic lymphadenectomy and radical prostatectomy: the positive impact of adjuvant radiotherapy

Published on May 1, 2009in European Urology20.096
· DOI :10.1016/J.EURURO.2009.01.046
Luigi F. Da Pozzo34
Estimated H-index: 34
,
Cesare Cozzarini43
Estimated H-index: 43
+ 10 AuthorsPatrizio Rigatti89
Estimated H-index: 89
Sources
Abstract
Abstract Background Recent large, prospective, randomised studies have demonstrated that adjuvant radiotherapy (RT) is a safe and effective procedure for preventing disease recurrence in locally advanced prostate cancer (PCa) patients. However, no study has ever tested the role of adjuvant RT in node-positive patients after radical prostatectomy (RP). Objective We hypothesised that adjuvant RT with early hormone therapy (HT) might improve long-term outcomes of patients with PCa and nodal metastases treated with RP and extended pelvic lymph node dissection (ePLND). Design, setting, and participants This retrospective study included 250 consecutive patients with pathologic lymph node invasion. We assessed factors predicting long-term biochemical recurrence (BCR)–free and cancer-specific survival (CSS) in node-positive PCa patients treated with RP, ePLND, and adjuvant treatments between 1988 and 2002 in a tertiary academic centre. Intervention All patients received adjuvant treatments according to the treating physician after detailed patient information: 129 patients (51.6%) were treated with a combination of RT and HT, while 121 patients (48.4%) received adjuvant HT alone. Measurements BCR-free survival and CSS in patients with node-positive PCa. Results and limitations Mean follow-up was 95.9 mo (median: 91.2). BCR-free survival and CSS rates at 5, 8, and 10 yr were 72%, 61%, 53% and 89%, 83%, 80%, respectively. In multivariable Cox regression models, adjuvant RT and the number of positive nodes were independent predictors of BCR-free survival ( p =0.002 and p =0.003, respectively) as well as of CSS ( p =0.009 and p =0.01, respectively). Moreover, there was significant gain in predictive accuracy when adjuvant RT was included in multivariable models predicting BCR-free survival and CSS (gain: 3.3% and 3%, respectively; all p Conclusions Our data showed excellent long-term outcome for node-positive PCa patients treated with radical surgery plus adjuvant treatments. This study is the first to report a significant protective role for adjuvant RT in BCR-free survival and CSS of node-positive patients.
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References30
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#1Alberto BrigantiH-Index: 99
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#1Martin C. Schumacher (University of Bern)H-Index: 14
#2Fiona C. Burkhard (University of Bern)H-Index: 51
Last. Urs E. Studer (University of Bern)H-Index: 85
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Abstract Background Conflicting results exist regarding the value of an extended pelvic lymph node dissection (PLND) in node-positive patients undergoing radical retropubic prostatectomy (RRP) for clinically localized prostate cancer. Objective To assess the long-term outcome in node-positive patients who underwent extended PLND followed by RRP. Design, setting, and participants A consecutive series of 122 node positive patients with negative preoperative staging examinations, no neoadjuvant hor...
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#1Ofer Yossepowitch (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 33
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Last. James A. Eastham (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 109
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Objectives Commonly used definitions for high-risk prostate cancer identify men at increased risk of PSA relapse after radical prostatectomy (RP). We assessed how accurately these definitions identify patients likely to receive secondary cancer therapy, experience metastatic progression, or die of prostate cancer.
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#1Stephen A. Boorjian (Mayo Clinic)H-Index: 83
#2R. Houston Thompson (Mayo Clinic)H-Index: 80
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#1Axel Heidenreich (University of Cologne)H-Index: 73
#2Carsten H. Ohlmann (University of Cologne)H-Index: 5
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Last. Patrick C. Walsh (Johns Hopkins University)H-Index: 148
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Last. Hendrik Van Poppel (Katholieke Universiteit Leuven)H-Index: 83
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Abstract Objectives The optimal management of locally advanced prostate cancer (cT3) is still a matter of debate. The objective of this study is to present 10-year outcomes of radical prostatectomy (RP) in unilateral cT3a disease. Patients and methods Between 1987 and 2004, 2273 patients underwent RP at our institution. Two hundred and thirty-five (10.3%) patients were assessed as unilateral cT3a disease by digital rectal examination. Thirty-five patients who received neoadjuvant treatment befor...
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#1Ian M. ThompsonH-Index: 114
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