Extensive PLND May Improve Prostate Cancer Outcomes

The extent of pelvic lymph node dissection (PLND) significantly affects the likelihood of biochemical recurrence (BCR) in patients with organ-confined prostate cancer (PCa), researchers reported at the American Urological Association 2011 annual meeting.

The investigators, led by Alberto Briganti, MD, of Vita-Salute University San Raffaele, Urological Research Institute, Milan, Italy, studied 1,368 patients who had pT2 PCa and negative nodes and surgical margins. All underwent extensive PLND. Men were divided into two groups according to the number of nodes removed: fewer than 20 and 20 or more. The researchers assessed BCR—which they defined as two consecutive PSA values above 0.2 ng/mL—at two, five, and eight years after surgery.

Overall, the mean number of nodes removed was 16.6 (median 16; range 6-48). The pathological Gleason sum was 6, 3+4, 4+3, and 8-10 in 56.1%, 32.4%, 8.4% and 3.1% of patients, respectively. The mean pre-operative PSA was 7.86 ng/mL (median 6.5; range 0.4-71.9). The mean prostate weight was 53.2 grams (median 48.6; range 4-250).

No patient received adjuvant treatment.

Of the 1,368 men, 984 (71.9%) and 384 (28.1%) had fewer than 20 and 20 or more lymph nodes removed, respectively. The two groups did not differ in terms of pre-operative and pathological characteristics. BCR-free survival at five, eight, and 10 years was 88%, 82%, 75% for patients with fewer than 20 nodes removed, and 93%, 90%, 90% in those with 20 or more nodes removed, a significant difference between the groups.

Compared with men who had fewer than 20 nodes removed, those who had 20 or more nodes removed were 50% more likely to be free from BCR, after adjusting for age, preoperative PSA, pathologic Gleason sum, and prostate weight.