Good outcome for patients with few lymph node metastases after radical retropubic prostatectomy

Eur Urol. 2008 Aug;54(2):344-52. doi: 10.1016/j.eururo.2008.05.023. Epub 2008 May 21.


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 hormonal or radiotherapy, and who underwent extended PLND (>/=10 lymph nodes in the surgical specimen) followed by RRP were analyzed. None of the patients received immediate androgen deprivation therapy (ADT).

Intervention: All patients underwent extended PLND followed by RRP.

Measurements: Biochemical recurrence-free survival, cancer-specific, and overall survival were assessed using the Kaplan-Meier technique.

Results and limitations: Median prostate-specific antigen (PSA) was 16ng/ml. At pathological examination 76% of the 122 patients had pT3-pT4 tumours, 50% seminal vesicle infiltration. A median of 22 nodes were removed per patient. Median cancer-specific survival at 5 and 10 yr was 84.5% and 60.1%, respectively. In patients with </=2 or >/=3 positive nodes removed, median cancer-specific survival at 10 yr was 78.6% and 33.4%, respectively (p<0.001). After a median period of 33 mo, 61 of the 122 patients (50%) received ADT, particularly those (69%) with >/=3 positive nodes removed. This retrospective study includes a significant percentage of patients with high tumour burden, and therefore may not reflect current patient series.

Conclusions: Patients with </=2 positive nodes detected after extended PLND followed by RRP had good long-term results and should not be denied treatment with curative intent. In contrast, prognosis was poor in patients with >/=3 positive nodes, despite extended PLND and despite ADT in 69% of patients.

MeSH terms

  • Adult
  • Aged
  • Humans
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Prostatectomy*
  • Prostatic Neoplasms / mortality
  • Prostatic Neoplasms / pathology*
  • Prostatic Neoplasms / surgery*
  • Survival Rate
  • Time Factors
  • Treatment Outcome