Prognosis 'excellent' in aggressively treated node-positive PCa patients

May 19, 2008

Results of a retrospective multinational collaborative study undertaken to identify factors predicting long-term, prostate cancer-specific survival in men with node-positive prostate cancer confirm that excellent clinical outcomes can be achieved when these patients are treated with a multimodal approach combining radical prostatectomy, pelvic lymph node dissection, and adjuvant hormonal treatment, investigators reported at the AUA annual meeting.

Results of a retrospective multinational collaborative study undertaken to identify factors predicting long-term, prostatecancer-specific survival in men with node-positive prostate cancer confirm that excellent clinical outcomes can be achievedwhen these patients are treated with a multimodal approach combining radical prostatectomy, pelvic lymph node dissection, andadjuvant hormonal treatment, investigators reported at the AUA annual meeting.

The study included 696 men who underwent radical prostatectomy and pelvic lymph node dissection at Vita-Salute San Raffaele University inMilan, Italy, or the Mayo Clinic, Rochester, MN, between January 1988 and January 2003. All men received adjuvant hormonaltreatment, and about one-fourth received adjuvant radiotherapy as well.

Median follow-up for the cohort was 112 months, and 2-, 5-, and 10-year cancer-specific survival rates calculated withKaplan-Meier curves were 97%, 90%, and 82%, respectively.

Various clinicopathologic factors and the use of adjuvant radiotherapy were investigated for their association withcancer-specific survival using univariate and multivariate Cox regression models. In the multivariate analyses, the number ofpositive lymph nodes, pathologic Gleason score, surgical margin status, and use of adjuvant radiotherapy were identified asindependent, statistically significant predictors of cancer-specific survival. Based on those four factors, a nomogramdemonstrated reasonably high bootstrap-corrected predictive accuracy of about 73%.

"At Mayo and Vita-Salute University, a similar approach is undertaken in the management of men with prostate cancer found tohave positive lymph nodes at radical prostatectomy in terms of not aborting the prostatectomy, performing complete pelviclymph node dissection, and routinely providing adjuvant hormonal treatment," said R. Jeffrey Karnes, MD, of the Mayo GraduateSchool of Medicine, who worked on the study with Michael Blute, MD, and colleagues.

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