MP64-10 IS THERE AN AGE LIMIT FOR THE INDICATION OF EXTENDED PELVIC LYMPH NODE DISSECTION DURING RADICAL PROSTATECTOMY IN PATIENTS WITH CLINICALLY LOCALIZED PROSTATE CANCER? (2017)

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy V1 Apr 2017MP64-10 IS THERE AN AGE LIMIT FOR THE INDICATION OF EXTENDED PELVIC LYMPH NODE DISSECTION DURING RADICAL PROSTATECTOMY IN PATIENTS WITH CLINICALLY LOCALIZED PROSTATE CANCER? Alessandro Larcher, Nicola Fossati, Giorgio Gandaglia, Umberto Capitanio, Paolo Dell'Oglio, Emanuele Zaffuto, Nazareno Suardi, Marco Bandini, Shahrokh Shariat, Francesco Montorsi, and Alberto Briganti Alessandro LarcherAlessandro Larcher More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Paolo Dell'OglioPaolo Dell'Oglio More articles by this author , Emanuele ZaffutoEmanuele Zaffuto More articles by this author , Nazareno SuardiNazareno Suardi More articles by this author , Marco BandiniMarco Bandini More articles by this author , Shahrokh ShariatShahrokh Shariat More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1983AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Available recommendations for extended lymph node dissection [eLND] at radical prostatectomy [RP] do not consider patient age, but rely on cancer characteristics only. However, for patients with limited life-expectancy, eLND might be an overtreatment. We hypothesized that limited life-expectancy of older RP candidates might dilute any beneficial effect of eLND in terms of cancer staging and outcomes. Therefore, we aimed at assessing the differential effect of age on the risk of lymph node invasion [LNI] and mortality due to cause other than prostate cancer [OCM] in order to define an age limit above which eLND might be avoided. METHODS We included 3,906 patients diagnosed with prostate cancer and treated with RP and an anatomically defined eLND at a single Institution. Logistic and Cox regression analyses were used to compute the risk of LNI at eLND and the risk of OCM 10 years after RP. Predictors of LNI were chosen in compliance with guidelines-recommended models and were PSA, primary and secondary biopsy Gleason score and clinical stage. Predictors of OCM were age at surgery, Charlson comorbidity index [CCI] and year of surgery. Locally weighted scatterplot smoothing method was used to graphically examine the differential effect of age on the risk of LNI and OCM. RESULTS Median age was 65 years. LNI rate was 12%. 10-year OCM rate was 5%. PSA (odd ratio [OR] 1.06; p<0.001), primary (OR 5.32; p<0.001) and secondary (OR 2.27; p<0.001) biopsy Gleason score ≥4 as well as clinical stage cT2 (OR 2.4; p<0.001) and cT3 (OR 3.24; p<0.001) were associated with higher LNI risk. Age (hazard ratio [HR] 1.11; p<0.001) and CCI (HR 1.28; p=0.03) were associated with higher OCM risk. Year of surgery (HR 0.92; p<0.001) was associated with lower OCM risk. For patients aged 75 or younger, the risk of LNI (8-11%) was higher than the risk of OCM (<1-10%; Figure 1). Conversely, for patients aged 76 or older the risk of LNI (11-17%) was equal or lower than the risk of OCM (11-26%). CONCLUSIONS For RP candidates older than 75 years, the risk of OCM equals or exceeds the risk of LNI. Such relatively high risk of OCM compared to the relatively low risk of LNI casts relevant doubts on any potential benefit related to eLND at RP. These findings argue against the routine use of eLND for older patients in clinical practice. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e848 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Alessandro Larcher More articles by this author Nicola Fossati More articles by this author Giorgio Gandaglia More articles by this author Umberto Capitanio More articles by this author Paolo Dell'Oglio More articles by this author Emanuele Zaffuto More articles by this author Nazareno Suardi More articles by this author Marco Bandini More articles by this author Shahrokh Shariat More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...