Biochemical Relapse in Low-risk Prostate Cancer Treated with Radical Prostatectomy and Bilateral Pelvic Lymphadenectomy

Abstract

Introduction For low-risk prostate cancer (PCa), curative treatment with radical prostatectomy (RP) can be performed, reporting a biochemical relapse-free survival rate (bRFS) at 5 and 7 years of 90.1% and 88.3%, respectively. Prostatic specific antigen (PSA), pathological stage (pT), and positive margins (R1) are significant predictors of biochemical relapse (BR). Even though pelvic lymphadenectomy is not recommended during RP, in the literature, it is performed in 34% of these patients, finding 0.37% of positive lymph nodes (N1). In this study, we aim to evaluate the 10-year bRFS in patients with low-risk PCa who underwent RP and extended pelvic lymph node dissection (ePLND).

Methodology All low-risk patients who underwent RP plus bilateral ePLND at the National Cancer Institute of Colombia between 2006 and 2019 were reviewed. Biochemical relapse was defined as 2 consecutive increasing levels of PSA > 0.2 ng/mL. A descriptive analysis was performed using the STATA 15 software (Stata Corp., College Station, TX, USA), and the Kaplan-Meier curves and uni and multivariate Cox proportional hazard models were used for the survival outcome analysis. The related regression coefficients were used for the hazard ratio (HR), and, for all comparisons, a two-sided p-value ˂ 0.05 was used to define statistical significance.

Results Two hundred and two patients met the study criteria. The 10-year bRFS for the general population was 82.5%, statistically related to stage pT3 (p = 0.047), higher Gleason grade group (GG) (p ≤ 0.001), and R1 (p ≤ 0.001), but not with N1. A total of 3.9% of the patients had N1; of these, 75% had R1, 25% GG2, and 37% GG3. Among the N0 (non-lymph node metástasis in prostate cáncer) patients, 31% of the patients had R1, 41% GG2, and 13% GG3.

Conclusions Our bRFS was 82.5% in low-risk patients who underwent RP and ePLND. With higher pT, GG, and presence of R1, the probability of BR increased. Those with pN1 (pathologicaly confirmed positive lymph nodes) were not associated with bRFS, with a pN1 detection rate of 3.9%.

Details: In low-risk PCa, curative treatment with RP can be performed, reporting a bRFS rate at 5 and 7 years of 90.1% and 88.3%, respectively. Despite the fact that pelvic lymphadenectomy is not recommended during RP in clinical guidelines, in the literature, it is performed in 34% of these patients, finding 0.37% of N1. In this study, we report the 10-year bRFS in patients with low-risk PCa who underwent surgery.

Keywords

prostate cancer - low risk - lymph node invasion - nomogram - pelvic lymphadenectomy - radical prostatectomy - relapse-free survival

Publication History

Received: 09 November 2021

Accepted: 18 February 2022

Article published online:
28 September 2022

• References

• 1 Mitsuzuka K, Koie T, Narita S. et al. Is pelvic lymph node dissection required at radical prostatectomy for low-risk prostate cancer?. Int J Urol 2013; 20 (11) 1092-1096
• 2 Abdollah F, Sun M, Suardi N. et al; National Comprehensive Cancer Network. National Comprehensive Cancer Network practice guidelines 2011: Need for more accurate recommendations for pelvic lymph node dissection in prostate cancer. J Urol 2012; 188 (02) 423-428
• 3 Guidelines EAU. Prostate Cancer | Uroweb [Internet]. [cited 2020 Jan 15]. Available from: https://uroweb.org/guideline/prostate-cancer/
• 4 Chalfin HJ, Feng Z, Trock BJ, Partin AW. Patterns of Pelvic Lymph Node Dissection at the Time of Radical Prostatectomy for Low-risk Men. Urology 2017; 104: 143-149
• 5 Daimon T, Miyajima A, Maeda T. et al. Does pelvic lymph node dissection improve the biochemical relapse-free survival in low-risk prostate cancer patients treated by laparoscopic radical prostatectomy?. J Endourol 2012; 26 (09) 1199-1202
• 6 Suardi N, Larcher A, Haese A. et al; EAU Young Academic Urologists–Robotic Section. Indication for and extension of pelvic lymph node dissection during robot-assisted radical prostatectomy: an analysis of five European institutions. Eur Urol 2014; 66 (04) 635-643
• 7 Naselli A, Andreatta R, Introini C, Fontana V, Puppo P. Omission of lymphadenectomy in low-risk prostate cancer. Anticancer Res 2007; 27 (6C( 4451-4456
• 8 Wang EH, Yu JB, Gross CP. et al. Variation in pelvic lymph node dissection among patients undergoing radical prostatectomy by hospital characteristics and surgical approach: results from the National Cancer Database. J Urol 2015; 193 (03) 820-825
• 9 Touijer KA, Sjoberg DD, Benfante N. et al. Limited versus Extended Pelvic Lymph Node Dissection for Prostate Cancer: A Randomized Clinical Trial. Eur Urol Oncol 2021; 4 (04) 532-539
• 10 Ramos JG, Caicedo JI, Cataño JG. et al. Extended pelvic lymphadenectomy in patients with clinically localised prostate cancer: A prospective observational study. Actas Urol Esp 2016; 40 (07) 446-452
• 11 Gonzalez N, Varela R, Cespedes C, Lopez de Mesa B, Gonzalez J. Recaída bioquímica en cáncer de próstata de bajo riesgo tratados con prostatectomía radical y linfadenectomía pélvica. Urol Colomb 2020; 29: 123-128
• 12 Fergany A, Kupelian PA, Levin HS, Zippe CD, Reddy C, Klein EA. No difference in biochemical failure rates with or without pelvic lymph node dissection during radical prostatectomy in low-risk patients. Urology 2000; 56 (01) 92-95
• 13 Watkins JM, Laszewski M, Watkins PL, Dufan TA, Adducci C. Margin involvement at prostatectomy for clinically localized prostate cancer: does a low-risk group exist?. Pract Radiat Oncol 2015; 5 (01) e31-e36