Analyses of outcomes after long-term follow-up of men with pathologic node-positive prostate cancer (pN+ PCa) show the addition of radical retropubic prostatectomy (RRP) to surgical castration and pelvic lymphadenecctomy is associated with improved cancer-specific and overall survival, according to findings of a retrospective matched-cohort study presented at the AUA annual meeting.
“Because there is unmeasured selection bias and confounding that we cannot account for in an observational study, our findings would need to be confirmed with a randomized clinical trial in order to confidently recommend radical prostatectomy as the standard of care for men with node-positive prostate cancer,” said Bimal Bhindi, MD, of Mayo Clinic, Rochester, MN.
“Considering the data and our study’s strengths and while awaiting a definitive clinical trial, however, we believe that aggressive loco-regional resection may be worth considering in well-selected patients as a part of a multimodal approach in the management of men with node-positive prostate cancer,” added Dr. Bhindi, working with R. Jeffrey Karnes, MD, and colleagues.
Men included in the study had a minimum potential follow-up of 20 years. They were identified from among those diagnosed between 1967 and 1995 with pN+ PCa on pelvic lymphadenectomy who underwent early bilateral orchiectomy alone (382 men) or with RRP (79 men). The latter 79 men were matched 1:1 with men having orchiectomy alone based on age, year of surgery, clinical grade, clinical stage, number of positive nodes, and preoperative PSA (available for 34 men in each group; median value, 51.4 ng/mL).
Of the 158 men included in the study, 146 (92%) were followed until death. Among men undergoing orchiectomy only, 76 men died, including 60 from prostate cancer. In the RRP plus orchiectomy group, 70 men died during follow-up, including 28 from prostate cancer.