ABSTRACT
Objective
To analyze the effect on biochemical recurrence (BCR) of omitting PLND in subsequently upgraded/upstaged patients (pNx regret). Using
nomograms, patients with low to intermediate-risk prostate cancer can be selected
to omit a pelvic lymph node dissection (PLND) at the time of a radical prostatectomy
(RP). However, some patients will experience upgraded pathology and/or stage.
Materials and Methods
We searched a prospectively maintained single institution/multi-surgeon cohort of
patients treated by RP and >5-year follow-up. From 2006-2012, 1026 (521 pNx and 505
pN0/1) eligible patients with biopsy Gleason Score ≤3+4 and cT1c-cT2 undergoing RARP
were included in the study.
Results
Gleason upgrading from ≤3+4 to >3+4 and/or pT3-4 occurred in 17% of pNx and 32% of
pN0/N1 (p<0.001). BCR occurred in 5% of the pNx, and 7% of the PLND group. Five-year
BCR free survival was higher in the pNx group (94.7% vs. 91%, P = .048). BCR occurred in 3% in the non-pNx regret and 18% in the pNx regret patients.
However, with propensity score matching with pNx regret and pN0/N1 patients, 5-year
BCR free survival rates were similar (81% vs 77%, P = .466).
Conclusions
Low to favorable intermediate-risk patients who PLND was omitted and experienced upgrading
or upstaging (pNx regret), have a higher predicted BCR. However, when matched to a
similar cohort with pN0/N1, the BCR did not differ. Omission of a PLND does not appear
to alter the rates of BCR compared to PLND inclusion.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013.Eur Urol. 2014; 65: 124-137https://doi.org/10.1016/j.eururo.2013.09.046
- Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores.Eur Urol. 2012; 61: 480-487https://doi.org/10.1016/j.eururo.2011.10.044
- Mapping of pelvic lymph node metastases in prostate cancer.Eur Urol. 2013; 63: 450-458https://doi.org/10.1016/j.eururo.2012.06.057
- Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part I: risk stratification, shared decision making, and care options.J Urol. 2018; 199 (03): 683-690https://doi.org/10.1016/j.juro.2017.11.095
- NCCN guidelines insights: prostate cancer early detection, version 2.2016.J Natl Compr Canc Netw. 2016; 14: 509-519
- EAU-ESTRO-SIOG guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent.Eur Urol. 2017; 71 (04): 618-629https://doi.org/10.1016/j.eururo.2016.08.003
- Prostate cancer, version 2.2019, NCCN clinical practice guidelines in oncology.J Natl Compr Canc Netw. 2019; 17 (05): 479-505https://doi.org/10.6004/jnccn.2019.0023
- Surgeon-led prostate cancer lymph node staging: pathological outcomes stratified by robot-assisted dissection templates and patient selection.BJU Int. 2018; 122: 66-75https://doi.org/10.1111/bju.14164
- Robot-assisted extended pelvic lymph node dissection (PLND) at the time of radical prostatectomy (RP): a video-based illustration of technique, results, and unmet patient selection needs.BJU Int. 2011; 108: 993-998https://doi.org/10.1111/j.1464-410X.2011.10454.x
- NCCN clinical practice guidelines in oncology: prostate cancer.J Natl Compr Canc Netw. 2010; 8 (Feb): 162-200
- A streamlined three-dimensional volume estimation method accurately classifies prostate tumors by volume.Am J Surg Pathol. 2003; 27: 1291-1301https://doi.org/10.1097/00000478-200310000-00001
- Methods for constructing and assessing propensity scores.Health Serv Res. 2014; 49: 1701-1720https://doi.org/10.1111/1475-6773.12182
- Limited pelvic lymph node dissection does not improve biochemical relapse-free survival at 10 years after radical prostatectomy in patients with low-risk prostate cancer.Urology. 2008; 71: 141-145https://doi.org/10.1016/j.urology.2007.08.027
- Does pelvic lymph node dissection improve the biochemical relapse-free survival in low-risk prostate cancer patients treated by laparoscopic radical prostatectomy?.J Endourol. 2012; 26: 1199-1202https://doi.org/10.1089/end.2011.0589
- Utilization of pelvic lymph node dissection for patients with low-risk prostate cancer treated with robot-assisted radical prostatectomy.Clin Genitourin Cancer. 2017; 15 (12): e1001-e1006https://doi.org/10.1016/j.clgc.2017.05.013
- Effect of extended pelvic lymph node dissection on oncologic outcomes in patients with d'amico intermediate and high risk prostate cancer treated with radical prostatectomy: a multi-institutional study.J Urol. 2020; 203 (02): 338-343https://doi.org/10.1097/JU.0000000000000504
- Salvage lymph node dissection for nodal recurrent prostate cancer: a systematic review.Eur Urol. 2019; 76: 493-504https://doi.org/10.1016/j.eururo.2018.10.041
Article info
Publication history
Published online: March 04, 2021
Accepted:
January 7,
2021
Received:
September 24,
2020
Footnotes
Conflict of Interest: Dr. Davis; education grant from Intuitive Surgical and research support from Janssen and, Genome DX.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
