Oncologic outcomes of patients with lymph node invasion at prostatectomy and post-prostatectomy biochemical persistence

• Published in: Urologic oncology 2023-02, Vol.41 (2), p.105.e19-105.e23
• Main Authors: Perera, Marlon, Lebdai, Souhil, Tin, Amy L., Sjoberg, Daniel D., Benfante, Nicole, Beech, Benjamin B., Alvim, Ricardo G., Touijer, Adam S., Jenjitranant, Pocharapong, Ehdaie, Behfar, Laudone, Vincent P., Eastham, James A., Scardino, Peter T., Touijer, Karim A.
• Format: Article
• Language: English
• Subjects: Disease Progression; Humans; Lymph Node Excision; lymph nodes; Lymph Nodes - pathology; Lymphatic Metastasis - pathology; Male; Neoplasm Recurrence, Local - pathology; Prostate-Specific Antigen; Prostatectomy; Prostatectomy - methods; Prostatic neoplasms; Prostatic Neoplasms - pathology; Retrospective Studies; Survival analysis
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2022.10.021

•Biochemical persistence in patients with lymph node invasion post prostatectomy and lymph nodal invasion is a poorly studied cohort.•Irrespective of imaging findings, a majority of these patients with this clinical constellation received hormonal deprivation.•PSA persistence post prostatectomy with lymph node invasion is associated with high-risk of progression and prostate cancer specific mortality. Pathologic nodal invasion at prostatectomy is frequently associated with persistently elevated prostate-specific antigen (PSA) and with increased risk of disease recurrence. Management strategies for these patients are poorly defined. We aimed to explore the long-term oncologic outcomes and patterns of disease progression. We included men treated between 2000 and 2017 who had lymph node invasion at radical prostatectomy and persistently detectable prostate-specific antigen post-prostatectomy. Postoperative imaging and management strategies were collated. Patterns of recurrence and probability of metastasis-free survival, prostate cancer–specific survival, and overall survival (OS) were assessed. Among our cohort of 253 patients, 126 developed metastasis. Twenty-five had a positive scan within 6 months of surgery; of these, 15 (60%) had a nodal metastasis, 10 (40%) had a bone metastasis, and 4 (16%) had local recurrence. For metastasis-free survival, 5- and 10-year probabilities were 52% (95% CI 45%, 58%) and 37% (95% CI 28%, 46%), respectively. For prostate cancer–specific survival, 5- and 10-year probabilities were 89% (95% CI 84%, 93%) and 67% (95% CI 57%, 76%), respectively. A total of 221 patients proceeded to hormonal deprivation treatment alone. Ten patients received postoperative radiotherapy. Biochemical persistence in patients with lymph node invasion is associated with high risk of disease progression and reduced prostate cancer–specific survival. Management was hindered by the limitation of imaging modalities utilized during the study period in accurately detecting residual disease. Novel molecular imaging may improve staging and help design a therapeutic strategy adapted to patients’ specific needs.