Impact of minimal lymph node metastasis on long-term prognosis after radical prostatectomy
Schmid, H.P.; Mihatsch, M.J.; Hering, F.; Rutishauser, G.
European Urology 31(1): 11-16
1997
ISSN/ISBN: 0302-2838 PMID: 9032528 Document Number: 477957
Objectives: In the management of clinically localized prostate cancer, understaging is of major concern. There is a considerable therapeutic dilemma in those patients in whom staging lymphadenectomy prior to intended radical prostatectomy reveals lymph node metastases. Methods: Pelvic lymph node dissection and radical retropubic prostatectomy were performed in 132 consecutive patients. Patients with extracapsular disease and/or positive lymph nodes received adjuvant radiotherapy. Median follow-up after surgery was 7 years and 2 months. To study the influence of minimal lymph node metastasis, category pN-1 was further subdivided into pN-1.1 and pN-1.2. Involvement of the prostatic capsule was either classified as infiltration (pT-3.1) or perforation (pT-3.2) of the capsule. Results: Disease-free survival after 10 years was 58% in patients with negative nodes, 37% in category pN-1.1, 25% in category pN-1.2 and 10% in category pN-2. Corrected overall survival was 83% for node-negative patients and 73% for category pN-1.1, but it was only 33% for pN-1.2 and 29% for pN-2. Patients in category pT3.1 had a statistically significant better survival than those in pT-3.2. Conclusions: We conclude that radical prostatectomy combined with adjuvant radiotherapy is a valuable option in prostate cancer patients with minimal lymph node metastasis. When compared to infiltration of the capsule, complete capsular perforation does adversely affect prognosis.