The impact of extended lymph node dissection versus neoadjuvant therapy with limited lymph node dissection on biochemical recurrence in high-risk prostate cancer patients treated with radical prostatectomy: a multi-institutional analysis

• Published in: Medical oncology (Northwood, London, England) Vol. 34; no. 1; p. 1
• Main Authors: Narita, Takuma, Koie, Takuya, Ookubo, Teppei, Mitsuzuka, Koji, Narita, Shintaro, Yamamoto, Hayato, Inoue, Takamitsu, Hatakeyama, Shingo, Kawamura, Sadafumi, Tochigi, Tatsuo, Habuchi, Tomonori, Arai, Yoichi, Ohyama, Chikara
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.01.2017; Springer Nature B.V
• Subjects: Aged; Antibiotics, Antineoplastic - therapeutic use; Chemotherapy, Adjuvant; Estramustine - administration & dosage; Gonadotropin-Releasing Hormone - administration & dosage; Hematology; Humans; Internal Medicine; Lymph Node Excision; Lymph Nodes - pathology; Lymph Nodes - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Neoadjuvant Therapy; Neoplasm Metastasis; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - prevention & control; Oncology; Original Paper; Pathology; Prostatic Neoplasms - drug therapy; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Retrospective Studies; Risk Factors; Neoadjuvant therapy; Prostatectomy; Extended lymph node dissection; High-risk prostate cancer
• ISSN: 1357-0560; 1559-131X; 1559-131X
• DOI: 10.1007/s12032-016-0859-0

The optimal treatment for high-risk prostate cancer (Pca) remains to be established. The current guidelines recommend extended pelvic lymph node dissection (e-PLND) for selected intermediate- and high-risk patients treated with RP. However, the indications, optimal extent, and therapeutic benefits of e-PLND remain unclear. The aim of this study was to assess whether e-PLND confers an oncological benefit for high-risk Pca compared to neoadjuvant luteinizing hormone-releasing hormone and estramustine (LHRH + EMP). The Michinoku Urological Cancer Study Group database contained the data of 2403 consecutive Pca patients treated with RP at four institutes between March 2000 and December 2014. In the e-PLND group, we identified 238 high-risk Pca patients who underwent RP and e-PLND, with lymphatic tissue removal around the obturator and the external iliac regions, and hypogastric lymph node dissection. The neoadjuvant therapy with limited PLND (l-PLND) group included 280 high-risk Pca patients who underwent RP and removal of the obturator node chain between September 2005 and June 2014 at Hirosaki University. The outcome measure was BRFS. The 5-year biochemical recurrence-free survival rates for the neoadjuvant therapy with l-PLND group and e-PLND group were 84.9 and 54.7%, respectively ( P  < 0.0001). The operative time was significantly longer in the e-PLND group compared to that of the neoadjuvant therapy with l-PLND group. Grade 3/4 surgery-related complications were not identified in both groups. Although the present study was not randomized, neoadjuvant LHRH + EMP therapy followed by RP might reduce the risk of biochemical recurrence.