局部淋巴轉移前列腺根除術後長期追蹤結果

-楊啟瑞, 吳錫金, 張兆祥, 黃志平, , 李建儀, 王賢祥, 楊晨洸,

中國醫藥大學附設醫院泌尿部及台中榮民總醫院泌尿部

The long-term survival outcome of radical prostatectomy for localized prostate cancer with positive lymph node

 Chi-rei Yang1, Hsi-chin Wu1, Chao-hsiang Chang1,Chi-ping Hwang

Department of Urology, China Medical University Hospital (CMUH),

Department of Urology, Taichung Veterans General Hospital (TCVGH),

Taichung, Taiwan

Purpose:

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 Nov 2019, 506 patients with localized prostate cancer underwent retropubic radical prostatectomy in TVGH and CMUH. Of them 55 patients with pathologic positive lymph nodes were under analysis for post operative outcome and long term follow up results. 80% of them had followed at least 10 years or until to death. Patient’s age ranged from 45 to 77 with a mean age of 65.2. According Nccn Criteria, Nine patients (9%) were as intermediate risk and 28(51%) as high risk and 18(33%) as very high risk. Following radical prostatectomy, Patients were followed PSA at 6^th 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 time to progression, overall survival and disease–specific survival rate calculated by using Kaplan Meier’s life-table.

Results:

Seventeen (31%) had one node positive, 17(31%) had two nodes positive, 7(13%) had three nodes positive and 15 (27%) had >3 positive nodes. Following radical prostatectomy, PSA were undetectable(<0.2ng/ml) in 22 (40%) patients. One and five years progression free survival rate were 30 and 14 %. The overall 5 and 10 years survival rate were 85 and 66%. The 5 and 10 years disease-specific survival rate were 92 and 70% respectively. Number of positive nodes corelated to clinical outcome.  

Conclusions:

Node positive may not indicate systemic disease. Extend nodes dissection plus radical prostatectomy may produce durable period of disease free for some patients. 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. Following ADT and RT, some patients may have maintained with free of ADT therapy. .