楊啟瑞, 吳錫金, 張兆祥, 黃志平, 歐晏泉, 裘坤元, 蘇重光, 陳文銘, 李建儀, 王賢祥, 楊晨洸, 程千里
The outcome and survival of radical prostatectomy for localized prostate cancer with positive lymph node
Chi-rei Yang1, Hsi-chin Wu1, Chao-hsiang Chang1, Yen-chuan Ou2, Chen-li Cheng2
Department of Urology, China Medical University Hospital, Taichung, Taiwan;
Division of Urology, Department of Surgery, Taichung Veterans General Hospital;2 Taichung, Taiwan
Although the indication of radical prostatectomy for lymph node-positive prostate cancer is controversy in past decades, the incidence of lymph node-positive prostate cancer is still common in high risk disease and the challenge remains on how well to treat these patients. Only long-term follow-up can give a true indication of the outcome in prostate cancer. Here we evaluated our experience in treating lymph node-positive prostate cancer following radical prostatectomy with more than ten years follow up.
Materials and Methods:
From Jan 1990 to Dec 2010, 453 patients with localized prostate cancer underwent retropubic radical prostatectomy by one surgeon (Chi-rei Yang) were evaluated. Of them 51 patients with pathologic positive lymph nodes were under analysis for postoperative outcome and long term follow up results. Over 89% of them had followed at least 10 years or until to death. Patient’s age ranged from 45 to 75 with a mean age of 61.2 compare to 65 of the whole series.65.2.. Following radical prostatectomy, Patients were followed PSA at 6th weeks and then very two months at initial 6 months and every 3 months further without adjuvant treatment. Salvage ADT with or without RT for PSA progressive rising > 0.3 ng/ml. The progression free, overall survival and disease–specific survival rate calculated by using Kaplan Meier’s life-table.
Totally 51 patients with positive nodes, sixteen (31%) had one positive node , 17(33%) had two nodes 6 (12%) positive and 12 (24%) had >3 positive nodes. Six weeks following RP. PSA was undetectable(<0.2ng/ml) in 18 (43%) patients. One and five years progression free survival rate were 30 and 14 %. The overall 5 and 10 years survival rate were 85 and 65%. The 5 and 10 years disease-specific survival rate were 90 and 70% respectively. Patients with 3 or less positive nodes demonstrate significant better cancer specific and overall survival results.
Node positive may not indicate systemic disease. Extend nodes dissection plus radical prostatectomy may produce durable period of disease free for patients with only 3 or less positive nodes. Long term disease control may achieve following salvage ADT with or without RT. The 5 and 10 overall and disease specific survival rate are higher compare to other reported series of Western countries. Further studies compare to patient cohort with RT only is warranted to prove how much benefit.