Multimodal course effective in node-positive prostate cancer


New data confirm that excellent clinical outcomes can be achieved when men with node-positive prostate cancer are treated with a multimodal approach combining radical prostatectomy, pelvic lymph node dissection, and adjuvant hormonal treatment, investigators reported.

Key Points

The study, a retrospective multinational collaborative effort undertaken to identify factors predicting long-term prostate cancer-specific survival in this patient population, was initiated by Alberto Briganti, MD, and colleagues at Vita-Salute San Raffaele University in Milan, Italy. They sought to increase statistical power and the opportunity for nomogram development by pooling their data with that of patients treated at the Mayo Clinic in Rochester, MN.

The study included 696 men who underwent radical prostatectomy and pelvic lymph node dissection at one of the two institutions between January 1988 and January 2003. All men received adjuvant hormonal treatment, and about one-fourth received adjuvant radiotherapy as well.

"At Mayo and Vita-Salute University, a similar approach is undertaken in the management of men with prostate cancer found to have positive lymph nodes at radical prostatectomy in terms of not aborting the prostatectomy and performing complete pelvic lymph node dissection and routinely providing adjuvant hormonal treatment," explained co-author R. Jeffrey Karnes, MD, assistant professor of urology at the Mayo Graduate School of Medicine.

"The oncologic results from this collaborative study validate our 2007 report in the Journal of Urology [178:864-70], where, based on 455 men, we found that long-term cancer-specific survival can be extremely good in these patients with locally and regionally advanced disease. Therefore, these men should not be denied potentially curative therapy."

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