OMITTING A LYMPH NODE DISSECTION AT RADICAL PROSTATECTOMY: ARE THERE CONSEQUENCES FOR UNEXPECTED UPGRADING/UPSTAGING?

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy V (MP66)1 Apr 2019MP66-07 OMITTING A LYMPH NODE DISSECTION AT RADICAL PROSTATECTOMY: ARE THERE CONSEQUENCES FOR UNEXPECTED UPGRADING/UPSTAGING? Muammer Altok, Brian Chapin, Surena Matin, Mary Achim, and John Davis* Muammer AltokMuammer Altok More articles by this author , Brian ChapinBrian Chapin More articles by this author , Surena MatinSurena Matin More articles by this author , Mary AchimMary Achim More articles by this author , and John Davis*John Davis* More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556939.64343.efAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Patients with low to favorable intermediate risk prostate cancer (or using a nomogram) may be selected for a radical prostatectomy treatment without a lymph node dissection. However, some patients may then experience upgrading or upstaging above such threshold--a term we have given “Nx Regret.” In this study, we explore the hypothesis that patients with Nx Regret pathology experience the same vs different biochemical relapse relate compared with a matched cohort of pN0/N1 selected cases. METHODS: The patient population is from an NCI designated comprehensive cancer center with multi-surgeon, high-volume experience in robotic prostatectomy and extended lymphadenectomy. Patients studied were treated from 2006-2012 to allow sufficient PSA follow-up. We constructed the study cohort of 521 pNx and 505 pN0/N1 patients with biopsy Gleason score 3+4 and cT1c-cT2. Cohorts were compared unadjusted and then with propensity score matching. RESULTS: Gleason upgrading from 3+4 to RP Gleason grade >3+4 and/or pT3-4 was observed in 17% of pNx (Nx Regret) and in 32% of pN0/N1 (p <0.001). BCR occurred in 5% in the Nx, and 7% in the PLND group. Five-year BCR free survival rate was higher in the Nx group (94.7% vs. 91%, p = 0.048). In the pNx group, Nx Regret and non-Nx Regret were compared. BCR occurred in 3% in the non-Nx Regret and 18% in the Nx Regret patients. Five-year BCR free survival rate was higher in the Non-Nx Regret group (98% vs. 81%, p <0.001). Finally, Nx Regret was compared with propensity score matched PLND (N0/N1) patients. Five-year BCR free survival rate was detected similar between groups (81% vs. 83%, p = 0.467, Fig.1). CONCLUSIONS: When low to favorable intermediate risk patients are selected for no PLND and experience upgrading or upstaging, they have a higher predicted BCR. However, when matched to similar patients with pN0/N1, the BCR was not different. We did not identify a testable hypothesis that the PLND adds therapeutic value in this patient group. Source of Funding: This study was supported in part by Cancer Center Core Grant (P30CA 16672) from the University of Texas MD Anderson Cancer Center. Houston, TX© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e960-e960 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Muammer Altok More articles by this author Brian Chapin More articles by this author Surena Matin More articles by this author Mary Achim More articles by this author John Davis* More articles by this author Expand All Advertisement PDF downloadLoading ...