MP54-10 COMPARISON BETWEEN LIMITED AND EXTENDED LYMPH NODE DISSECTION FOR PROSTATE CANCER: RESULTS FROM A LARGE, CLINICALLY-INTEGRATED, RANDOMIZED TRIAL (2019)

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III (MP54)1 Apr 2019MP54-10 COMPARISON BETWEEN LIMITED AND EXTENDED LYMPH NODE DISSECTION FOR PROSTATE CANCER: RESULTS FROM A LARGE, CLINICALLY-INTEGRATED, RANDOMIZED TRIAL Karim Touijer*, Daniel Sjoberg, Nicole Benfante, James Eastham, Vincent Laudone, Ehdaie Behfar, Peter Scardino, and Andrew Vickers Karim Touijer*Karim Touijer* More articles by this author , Daniel SjobergDaniel Sjoberg More articles by this author , Nicole BenfanteNicole Benfante More articles by this author , James EasthamJames Eastham More articles by this author , Vincent LaudoneVincent Laudone More articles by this author , Ehdaie BehfarEhdaie Behfar More articles by this author , Peter ScardinoPeter Scardino More articles by this author , and Andrew VickersAndrew Vickers More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556685.08836.60AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Pelvic lymph node dissection (PLND) in prostate cancer remains controversial. Although it represents the most reliable procedure for lymph node staging, a therapeutic benefit remains unproven and a consensus has not been reached as to what anatomical extent the PLND should be performed. METHODS: Between October 2011 and March 2017, 1573 men undergoing radical prostatectomy at Memorial Sloan Kettering Cancer Center consented to the trial. After 73 patients were randomized, the study design changed to cluster randomization with crossover. Each surgeon was randomized to use a limited (external iliac nodal packet) vs. extended (external iliac, obturator fossa and hypogastric nodal packets) PLND template for a 3-month period. At the end of the 3-month period, surgeons were once again randomized. The primary endpoint was time to biochemical recurrence defined as a PSA of >0.1 ng/mL followed by a confirmatory PSA rise. Cox regression was used to compare groups, using the sandwich estimator to allow for correlation within surgeon. RESULTS: A total of 1480 patients were registered: 757 randomized to the extended and 723 to the limited template. The median number of nodes retrieved was 12 (IQR 8, 17) and 14 (IQR 10, 20) The rate of positive nodes was 11.2% vs. 13.6% (risk difference 2.4%, 95% C.I. -1.0%, 5.8%, p=0.2) for the limited and extended PLND, respectively. There were no grade IV or V complications. Rates for grade II and III complications were almost identical (12% in limited vs. 11% in extended). There was no significant difference in biochemical recurrence between groups (hazard ratio 0.99; 95% CI 0.83, 1.17; p=0.9). CONCLUSIONS: The extended pelvic lymph node dissection did not improve freedom from biochemical recurrence over a limited node dissection in men with clinically localized prostate cancer. However, there was only a small difference in nodal count and the rate of positive nodes between the two templates. Source of Funding: none New York, NY© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e788-e788 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Karim Touijer* More articles by this author Daniel Sjoberg More articles by this author Nicole Benfante More articles by this author James Eastham More articles by this author Vincent Laudone More articles by this author Ehdaie Behfar More articles by this author Peter Scardino More articles by this author Andrew Vickers More articles by this author Expand All Advertisement PDF downloadLoading ...