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Prostate Cancer: Localized: Surgical Therapy II (PD19): Podium 19: Saturday, September 11, 2021


Rakic, Nikola; Rakic, Ivan; Keeley, Jacob; Meyer, Christian; Graefen, Markus; Pose, Randi; Tennstedt, Perre; Corsi, Nicholas; Bronkema, Chandler; Sood, Akshay; Arora, Sohrab; Rogers, Craig; Menon, Mani; Abdollah, Firas

doi: 10.1097/JU.0000000000002008.12
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Lymph-vascular invasion (LVI) at radical prostatectomy (RP) is recognized as an adverse pathological feature in patients with prostate cancer (PCa). Recent literature showed a detrimental impact of LVI on overall survival in all patients with PCa, regardless of risk stratification. That said, the predictive performance of LVI in patients with very have high-risk disease, where it could serve as a guide for the necessity of multimodal treatment has not been elucidated. We tested the hypothesis that LVI is an independent predictor of cancer-specific mortality (CSM) in patients with very high-risk PCa.


We included 2,058 PCa cM0 patients who underwent RP with lymph node dissection, between 2001 and 2019, in two tertiary care centers. Included patients were considered high-risk due to harboring ≥2 of the following adverse disease features: ≥pT3b stage, pathological Gleason 8-10, and/or positive nodal involvement (pN1). Cumulative incidence curves were used to estimate CSM, after accounting for other cause mortality. Regression analysis tested the relationship between LVI and CSM after accounting for the following covariates: PSA, pathological tumor stage, Gleason grade, pathological nodal status, and surgical margin status.


Within our cohort, most patients had a pT3b disease (86.2%), pN1 status (75.4%), positive margins (PSM) (73.9%), LVI (59.0%) and pathological Gleason 9 disease (69.1%). Median (IQR) follow-up of the cohort was 36 months (13-61). At 5-year, CSM rate was 11.2% in patients with LVI vs 7.2% in patients without LVI (p=.03). However, on multivariable analysis, LVI was not an independent predictor of less favorable CSM rate (hazard ratio [HR]:1.071, 95% CI:0.718–1.599, p=0.7366). Covariates that were found to be independent predictors of CSM included Gleason score ≥ 8 (HR: 5.668, 95% CI: 2.704-11.830, p<.0001), PSM (HR: 1.774, 95% CI: 1.080-2.915, p=.02), pN1 (HR: 2.147, 95% CI: 1.278-3.607, p=.003), and stage ≥ pT3b (HR: 3.113, 95% CI: 1.334-7.265, p=.008).


In patients with very high-risk PCa, where the stakes are the highest, and multimodal treatment is frequently discussed after radical prostatectomy, LVI fails to provide further guidance when compared to routinely available and utilized clinical and pathological features. In a quest to continuously optimize outcomes for our patients, our findings highlight an important shortcoming for LVI in very high-risk patients and further show the prognostic value of widely accepted adverse disease characteristics.

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© 2021 by American Urological Association Education and Research, Inc.