Outcome after radical prostatectomy with extended pelvic lymphadenectomy for untreated high-risk clinically localized prostate cancer

Abstract

(Purpose) We assessed the outcome after radical prostatectomy and extended pelvic lymphadenectomy in patients with untreated high-risk clinically localized prostate cancer, retrospectively. (Materials and methods) Between 2001 and 2010,89 patients for untreated high-risk clinically localized prostate cancer on the risk classification as defined by D'Amico, underwent retropubic radical prostatectomy and extended pelvic lymphadenectomy. Boundaries of the pelvic lymph node dissection field divided into external iliac vessels, obturator fossa, and internal iliac vessels. We investigated mainly the postoperative outcome of 84 patients without any adjuvant therapies. PSA recurrence-free survival among the pretreatment variables was estimated using Kaplan-Meier plots, and the statistical significance was determined by log rank test. (Results) In 89 high-risk patients, 32.7% had pT3-pT4 tumors, 16.9% positive surgical margin, 6.7% positive lymph node métastasés and 30.3% Gleason score 8-10 at the pathological examination. A median of 13 nodes (mean 14.0, range 9-25 nodes) were removed per patient. In 96.6% cases, postoperative PSA values decreased less than 0.2 ng/ml. The median observation period after operation was 1,819 days. Median PSA recurrence-free survival rates, overall survival and cancer cause-specific survival rates at 5 year, in 84 high-risk patients without any adjuvant therapies, were 73.8%, 100% and 100%, respectively. Median PSA recurrence-free survival rates according to pathological T stage and surgical margin status were statistically significant, but that according to preoperative 3 factors (clinical T stage, Gleason score at biopsy, preoperative PSA values) were statistically insignificant. Moreover, that according to both the number of positive preoperative 3 factors (1 vs. 2 positive factors) and the number of removed lymph nodes (≤13 vs. ≥14), were statistically insignificant. The median PSA recurrence-free survival rates at 5 year for positive margin cases were 0%. (Conclusion) Radical prostatectomy and extended pelvic lymphadenectomy is feasible in patients with high-risk clinically localized prostate cancer. We suggest that both wide resection and extended pelvic lymphadenectomy may improve the postoperative outcome for high-risk clinically localized prostate cancer. © 2013 The Japanese Urological Association.