MP70-21 ASSESSING THE OPTIMAL POST-OPERATIVE MANAGEMENT OF NODE POSITIVE PROSTATE CANCER PATIENTS:RESULTS FROM MULTI-INSTITUTIONAL SERIES (2014)

You have accessJournal of UrologyProstate Cancer: Advanced II1 Apr 2014MP70-21 ASSESSING THE OPTIMAL POST-OPERATIVE MANAGEMENT OF NODE POSITIVE PROSTATE CANCER PATIENTS:RESULTS FROM MULTI-INSTITUTIONAL SERIES Karim Touijer, Niccolò Maria Passoni, Alberto Briganti, Nazareno Suardi, Andrea Gallina, Nicola Fossati, Francesco Montorsi, and James Eastham Karim TouijerKarim Touijer More articles by this author , Niccolò Maria PassoniNiccolò Maria Passoni More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Nazareno SuardiNazareno Suardi More articles by this author , Andrea GallinaAndrea Gallina More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and James EasthamJames Eastham More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2585AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To date, the only level 1 evidence data support the role of adjuvant androgen deprivation therapy (ADT) for all men with positive lymph node (LNs). However, controversy exists on the validity of these findings in contemporary patients with micrometastatic LN disease. The aim of our study was to assess the optimal post-operative management of LN positive prostate cancer patients recruited from a large, multi-institutional series. METHODS We retrospectively reviewed 1338 LN positive patients treated with patients RP and extended pelvic lymph node dissection (ePLND) from 3 tertiary referral centers between 1988 and 2010. Patients were divided into three groups according to post-operative treatment status: observation (n=387; 27.9%), ADT (n=676;48.7%) or a combination of adjuvant radiation therapy (aRT) and ADT (n=325; 23.4%). Multivariable Cox competing risk models (MVA) assessing the impact of different adjuvant therapies on both cancer-specific mortality (CSM) and other-cause mortality (OCM) were fitted adjusting for age at surgery, pathological Gleason score (GS) and stage, number of positive LNs and surgical margin status (SM). RESULTS Median follow-up was 72 months (IQR 49-128 months). Median number of removed LNs was 14 (IQR 10-20). The median number of positive LNs was 1 (IQR 1-2). Patients managed with observation were younger, had lower PSA at surgery, had higher rates of pT2/pT3a disease and lower rates of positive SM, compared to men treated with ADT or RT-ADT combination, respectively (all p<0.0001). At 7 years after RP, actuarial cancer-specific survival rates were 84.7%, 88.4% and 93.8% while overall survival rates were 82.8%, 79.4% and 90.0% for men treated with observation, ADT and aRT + ADT, respectively (p=0.002 and p=0.02, respectively). At MVA predicting CSM, ADT (SHR 0.64; p=0.03) and RT + ADT (SHR 0.26; p<0.0001) were significantly associated with a decreased risk of CSM. Other significant predictors of CSM were GS ≥8, advanced pathological stage, positive SM and higher number of positive LNs (all p<0.007). Conversely, ADT was significantly associated with increased OCM (SHR 3.03; p=0.003) at MVA, while RT-ADT combination was not (SHR 2.0; p=0.12). Older age was also a significant predictor of OCM (p<0.0001). CONCLUSIONS Multimodal treatment seems to confer the best cancer control with the least impact on OCM in patients with positive LNs after RP and ePLND. Whether this is true for all men with node positive disease still needs to be demonstrated. Further prospective studies are needed to corroborate these findings. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e814 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Karim Touijer More articles by this author Niccolò Maria Passoni More articles by this author Alberto Briganti More articles by this author Nazareno Suardi More articles by this author Andrea Gallina More articles by this author Nicola Fossati More articles by this author Francesco Montorsi More articles by this author James Eastham More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...