INTRODUCTION AND OBJECTIVE:
Extended pelvic lymph node dissection (ePLND) increases detection rate of lymph node positive prostate cancer compared to limited pelvic lymph node dissection (lPLND); improvement of patient outcomes remains questionable. A few studies have suggested that the benefit from ePLND may been seen in certain subgroups of prostate cancer such as those with a higher Gleason grade. Here we report and compare 3-year postoperative PSA recurrence rates between patients that underwent lPLND versus ePLDN at time of prostatectomy.
162 patients received a lPLND (removed periprostatic, external iliac and obturator lymph nodes bilaterally) and 142 patients received an ePLND (removed periprostatic, external iliac, obturator, hypogastric and common iliac nodes bilaterally). Decision to undergo ePLND versus lPLND was based on the NCCN guideline. Median follow up time was 7 and 3 years for lPLND and ePLND patients respectively. Kaplan-Meier analysis was carried out to assess the impact of PLND on early postoperative PSA progression-free survival. Subgroup analyses were done for node-negative and node-positive patients as well as Gleason score.
Gleason score and T stage was not significantly different between patients who received an ePLND and lPLND (Table 1). pN1 rate for ePLND and lPLND were 21% (30/140) and 7% (12/162), respectively. There was no difference in the use of adjuvant treatments in the pN0 patients. Significantly more ePLND pN1 patients received adjuvant ADT (25/28 vs 5/10 p=0.012) and radiation (27/28 vs 4/10 p=0.002). Yet, no difference in BCR between ePLND and lPLND was observed (p=0.44). This remained true in subgroup analyses of node-positive (p=0.31), node-negative (p=0.79), Gleason Score 6-7 (p=0.51), and Gleason Score 8-10 (p=0.77) (Figure 1).
ePLND provides no additional diagnostic or therapeutic benefit, even though ePLND patients were significantly more likely to undergo adjuvant treatment, compared to a lPLND while increasing the morbidity of the surgical treatment of prostate cancer.
Source of Funding:
This work is supported in part by the cancer center support grant from the National Cancer Institute (P30CA072720)