Contemporary patterns of care and outcomes of men found to have lymph node metastases at the time of radical prostatectomy Journal Article


Authors: Zareba, P.; Eastham, J.; Scardino, P. T.; Touijer, K.
Article Title: Contemporary patterns of care and outcomes of men found to have lymph node metastases at the time of radical prostatectomy
Abstract: Purpose A thorough understanding of the natural history and consensus regarding the optimal management of pathological lymph node positive (pN1) prostate cancer are lacking. Our objective was to describe patterns of care and outcomes of a contemporary cohort of men with pN1 prostate cancer. Materials and Methods We used the National Cancer Database to identify 7,791 men who were found to have lymph node metastases at radical prostatectomy. Multinomial logistic regression and Cox proportional hazards regression were used to identify patient, tumor and facility characteristics associated with the choice of management strategy after radical prostatectomy and overall survival, respectively. Results Initial post-prostatectomy management was observation in 63% of the men, androgen deprivation therapy alone in 20%, radiation therapy alone in 5%, and androgen deprivation therapy and radiation therapy in 13%. Younger age, lower comorbidity burden, higher grade and stage, and positive surgical margins were associated with a higher likelihood of receiving combination therapy. Grade group 4–5 disease, pT3b-T4 disease, positive surgical margins and a higher number of positive lymph nodes were independent predictors of worse overall survival. The adjusted 10-year overall survival probability decreased from 84% to 32% with the presence of an increasing number of adverse prognostic factors. Treatment with combined androgen deprivation therapy and radiation therapy was associated with better overall survival (multivariable HR 0.69, 95% CI 0.52–0.92, p = 0.010 for combination therapy vs observation). Conclusions Patient and tumor characteristics are associated with the choice of management strategy after radical prostatectomy and survival in men with pN1 prostate cancer. Multimodal therapy may be of benefit in this patient population. © 2017 American Urological Association Education and Research, Inc.
Keywords: mortality; lymphatic metastasis; lymph node excision; prostatic neoplasms; prostatectomy
Journal Title: Journal of Urology
Volume: 198
Issue: 5
ISSN: 0022-5347
Publisher: Elsevier Science, Inc.  
Date Published: 2017-11-01
Start Page: 1077
End Page: 1084
Language: English
DOI: 10.1016/j.juro.2017.06.062
PROVIDER: scopus
PUBMED: 28625507
PMCID: PMC6049661
DOI/URL:
Notes: Article -- Export Date: 1 November 2017 -- Source: Scopus
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MSK Authors
  1. Peter T Scardino
    660 Scardino
  2. Karim Abdelkrim Touijer
    231 Touijer
  3. James Eastham
    495 Eastham