Positive nodes, Gleason score predict prognosis after lymph node metastasis
MedWire News: The prognosis for prostate cancer patients with lymph node (LN) metastasis may depend on the number of positive nodes removed at bilateral pelvic lymph node dissection (BPLND) as well as their radical prostatectomy (RP) Gleason score, show US study results.
"Patients with RP Gleason score 8 or higher and two or more positive LNs are at an increased risk for biochemical recurrence (BCR)," say Christian von Bodman, from the Memorial Sloan-Kettering Cancer Center in New York, and colleagues.
They add that these patients "should be considered candidates for adjuvant androgen deprivation therapy (ADT) or for enrollment in clinical trials to further investigate adjuvant therapy."
The team examined clinical and pathological predictors of BCR, defined as a prostate-specific antigen (PSA) level of 0.1 ng/ml or greater after RP with one confirmatory increase, in a cohort of 207 prostate cancer patients with LN metastasis. All patients underwent RP and BPLND, with 45 receiving adjuvant ADT.
The majority (59%) of patients had only one positive lymph node at BPLND; 21% had two, and 20% had three or more. Patients undergoing adjuvant ADT had a greater number of positive LNs, with 38% experiencing three or more, compared with 15% of patients without ADT.
A total of 69 (33%) men experienced BCR, with a median time to recurrence in patients with one, two, and three positive LNs of 59, 13, and 3 months, respectively. The researchers calculated the overall 24-month probability of freedom-from-BCR to be 55%.
After adjusting for potential confounders including pretreatment PSA level, Gleason score, and seminal vesicle invasion, multivariate analysis revealed that compared with a Gleason score of 7 or less, men with a Gleason score of 8 or higher were 2.04 times more likely to experience BCR.
Having two or three versus one positive lymph nodes also increased the risk for BCR, by a respective 1.16 and 3.11 fold.
Despite having a greater number of positive LNs, the group with the most favorable BCR-free probability were ADT-treated patients with an RP Gleason score of 7 or less, and one positive LN (n=61). These patients had a 79% risk for remaining BCR-free at 2 years after RP.
Thus the team concludes, in the Journal of Urology: "Full BPLND should be done in patients with intermediate and high risk cancer to optimally identify those with a minimal LN burden who may benefit the most from metastatic LN removal."
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By Sarah Guy