Oncologic outcomes of patients with lymph node invasion at prostatectomy and post-prostatectomy biochemical persistence Journal Article
| Authors: | Perera, M.; Lebdai, S.; Tin, A. L.; Sjoberg, D. D.; Benfante, N.; Beech, B. B.; Alvim, R. G.; Touijer, A. S.; Jenjitranant, P.; Ehdaie, B.; Laudone, V. P.; Eastham, J. A.; Scardino, P. T.; Touijer, K. A. |
| Article Title: | Oncologic outcomes of patients with lymph node invasion at prostatectomy and post-prostatectomy biochemical persistence |
| 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. © 2022 |
| Keywords: | adult; cancer chemotherapy; cancer survival; controlled study; middle aged; survival analysis; retrospective studies; major clinical study; overall survival; cancer recurrence; postoperative period; bone metastasis; cancer patient; cancer radiotherapy; nuclear magnetic resonance imaging; outcome assessment; positron emission tomography; lymph node metastasis; lymph node dissection; lymph nodes; lymphatic metastasis; lymph node excision; prostate specific antigen; computer assisted tomography; neoplasm recurrence, local; cohort analysis; pathology; retrospective study; prostate cancer; gleason score; prostate-specific antigen; prostatic neoplasms; prostatectomy; disease progression; cancer specific survival; tumor recurrence; lymph node; prostate tumor; fluorodeoxyglucose f 18; disease exacerbation; bone scintiscanning; clinical outcome; procedures; metastasis free survival; humans; human; male; article |
| Journal Title: | Urologic Oncology: Seminars and Original Investigations |
| Volume: | 41 |
| Issue: | 2 |
| ISSN: | 1078-1439 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2023-02-01 |
| Start Page: | 105.e19 |
| End Page: | 105.e23 |
| Language: | English |
| DOI: | 10.1016/j.urolonc.2022.10.021 |
| PUBMED: | 36435708 |
| PROVIDER: | scopus |
| PMCID: | PMC10391319 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF. Corresponding author is MSK author Karim A Touijer -- Export Date: 1 March 2023 -- Source: Scopus |
