Oncologic outcomes of patients with lymph node invasion at prostatectomy and post-prostatectomy biochemical persistence
Details
Publication Year 2023-02,Volume 41,Issue #2,Page 105.e19-105.e23
Journal Title
Urologic Oncology
Publication Type
Research article
Abstract
BACKGROUND: Pathologic nodal invasion at prostatectomy is frequently associated with persistently elevated prostate-specific antigen (PSA) and with increased risk of disease recurrence. Management strategies for these patients are poorly defined. We aimed to explore the long-term oncologic outcomes and patterns of disease progression. METHODS: We included men treated between 2000 and 2017 who had lymph node invasion at radical prostatectomy and persistently detectable prostate-specific antigen post-prostatectomy. Postoperative imaging and management strategies were collated. Patterns of recurrence and probability of metastasis-free survival, prostate cancer-specific survival, and overall survival (OS) were assessed. RESULTS: Among our cohort of 253 patients, 126 developed metastasis. Twenty-five had a positive scan within 6 months of surgery; of these, 15 (60%) had a nodal metastasis, 10 (40%) had a bone metastasis, and 4 (16%) had local recurrence. For metastasis-free survival, 5- and 10-year probabilities were 52% (95% CI 45%, 58%) and 37% (95% CI 28%, 46%), respectively. For prostate cancer-specific survival, 5- and 10-year probabilities were 89% (95% CI 84%, 93%) and 67% (95% CI 57%, 76%), respectively. A total of 221 patients proceeded to hormonal deprivation treatment alone. Ten patients received postoperative radiotherapy. CONCLUSIONS: Biochemical persistence in patients with lymph node invasion is associated with high risk of disease progression and reduced prostate cancer-specific survival. Management was hindered by the limitation of imaging modalities utilized during the study period in accurately detecting residual disease. Novel molecular imaging may improve staging and help design a therapeutic strategy adapted to patients' specific needs.
Publisher
Elsevier
Keywords
Male; Humans; *Prostate-Specific Antigen; Lymphatic Metastasis/pathology; Neoplasm Recurrence, Local/pathology; *Prostatic Neoplasms/pathology; Lymph Nodes/pathology; Lymph Node Excision; Disease Progression; Prostatectomy/methods; Retrospective Studies; Prostate-specific antigen; Prostatectomy; Prostatic neoplasms; Survival analysis; lymph nodes
Department(s)
Surgical Oncology
PubMed ID
36435708
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Creation Date: 2023-06-13 07:55:12
Last Modified: 2023-06-13 07:56:08

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