Advertisement

Medical Oncology

, 34:1 | Cite as

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

  • Takuma Narita
  • Takuya KoieEmail author
  • Teppei Ookubo
  • Koji Mitsuzuka
  • Shintaro Narita
  • Hayato Yamamoto
  • Takamitsu Inoue
  • Shingo Hatakeyama
  • Sadafumi Kawamura
  • Tatsuo Tochigi
  • Tomonori Habuchi
  • Yoichi Arai
  • Chikara Ohyama
Original Paper

Abstract

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.

Keywords

High-risk prostate cancer Prostatectomy Neoadjuvant therapy Extended lymph node dissection 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

References

  1. 1.
    Lester-Coll NH, Goldhaber SZ, Sher DJ, D’Amico AV. Death from high-risk prostate cancer versus cardiovascular mortality with hormonal therapy: a decision analysis. Cancer. 2013;119:1808–15.CrossRefPubMedGoogle Scholar
  2. 2.
    Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, et al. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol. 2014;65:124–37.CrossRefPubMedGoogle Scholar
  3. 3.
    Thompson I, Thrasher JB, Aus G, Burnett AL, Canby-Hagino ED, Cookson MS, et al. Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol. 2007;177:2106–31.CrossRefPubMedGoogle Scholar
  4. 4.
    Mohler JL, Armstrong AJ, Bahnson RR, D’Amico AV, Davis BJ, Eastham JA, et al. Prostate cancer, version 1.2016. J Natl Compr Cancer Netw. 2016;14:19–30.Google Scholar
  5. 5.
    Withrow DR, DeGroot JM, Siemens DR, Groome PA. Therapeutic value of lymph node dissection at radical prostatectomy: a population-based case-cohort study. BJU Int. 2011;108:209–16.CrossRefPubMedGoogle Scholar
  6. 6.
    Bivalacqua TJ, Gorin MA, Walsh PC. Anatomic extent of pelvic lymph node dissection: impact on long-term cancer-specific outcomes in men with positive lymph nodes at time of radical prostatectomy REPLY. Urology. 2013;82:659.CrossRefGoogle Scholar
  7. 7.
    Ji JD, Yuan HX, Wang LL, Hou JQ. Is the impact of the extent of lymphadenectomy in radical prostatectomy related to the disease risk? a single center prospective study. J Surg Res. 2012;178:779–84.CrossRefPubMedGoogle Scholar
  8. 8.
    Schiavina R, Bertaccini A, Garofalo M, Concetti S, Brunocilla E, Franceschelli A, et al. The impact of the extent of lymph-node dissection on biochemical relapse after radical prostatectomy in node-negative patients. Anticancer Res. 2010;30:1478–9.Google Scholar
  9. 9.
    Abdollah F, Gandaglia G, Suardi N, Capitanio U, Salonia A, Nini A, et al. More extensive pelvic lymph node dissection improves survival in patients with node-positive prostate cancer. Eur Urol. 2015;67:212–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Ploussard G, Briganti A, de la Taille A, Haese A, Heidenreich A, Menon M, et al. Pelvic lymph node dissection during robot-assisted radical prostatectomy: efficacy, limitations, and complications—a systematic review of the literature. Eur Urol. 2014;65:7–16.CrossRefPubMedGoogle Scholar
  11. 11.
    Harbin AC, Eun DD. The role of extended pelvic lymphadenectomy with radical prostatectomy for high-risk prostate cancer. Urol Oncol-Semin Ori. 2015;33:208–16.CrossRefGoogle Scholar
  12. 12.
    Chi KN, Chin JL, Winquist E, Klotz L, Saad F, Gleave ME. Multicenter phase II study of combined neoadjuvant docetaxel and hormone therapy before radical prostatectomy for patients with high risk localized prostate cancer. J Urol. 2008;180:565–70.CrossRefPubMedGoogle Scholar
  13. 13.
    Prayer-Galetti T, Sacco E, Pagano F, Gardiman M, Cisternino A, Betto G, et al. Long-term follow-up of a neoadjuvant chemohormonal taxane-based phase II trial before radical prostatectomy in patients with non-metastatic high-risk prostate cancer. BJU Int. 2007;100:274–80.CrossRefPubMedGoogle Scholar
  14. 14.
    Magi-Galluzzi C, Zhou M, Reuther AM, Dreicer R, Klein EA. Neoadjuvant docetaxel treatment for locally advanced prostate cancer—a clinicopathologic study. Cancer. 2007;110:1248–54.CrossRefPubMedGoogle Scholar
  15. 15.
    Koie T, Ohyama C, Yamamoto H, Hatakeyama S, Yoneyama T, Hashimoto Y, et al. Safety and effectiveness of neoadjuvant luteinizing hormone-releasing hormone agonist plus low-dose estramustine phosphate in high-risk prostate cancer: a prospective single-arm study. Prostate Cancer P D. 2012;15:397–401.CrossRefGoogle Scholar
  16. 16.
    Koie T, Mitsuzuka K, Yoneyama T, Narita S, Kawamura S, Kaiho Y, et al. Neoadjuvant luteinizing-hormone-releasing hormone agonist plus low-dose estramustine phosphate improves prostate-specific antigen-free survival in high-risk prostate cancer patients: a propensity score-matched analysis. Int J Clin Oncol. 2015;20:1018–25.CrossRefPubMedGoogle Scholar
  17. 17.
    Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4.CrossRefPubMedGoogle Scholar
  18. 18.
    Epstein JI, Allsbrook WC Jr, Amin MB, Egevad LL, Committee IG. The 2005 International Society of Urological Pathology (ISUP) consensus conference on gleason grading of prostatic carcinoma. Am J Surg Pathol. 2005;29:1228–42.CrossRefPubMedGoogle Scholar
  19. 19.
    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.CrossRefPubMedGoogle Scholar
  20. 20.
    Weingartner K, Ramaswamy A, Bittinger A, Gerharz EW, Voge D, Riedmiller H. Anatomical basis for pelvic lymphadenectomy in prostate cancer: results of an autopsy study and implications for the clinic. J Urol. 1996;156:1969–71.CrossRefPubMedGoogle Scholar
  21. 21.
    Davis JW, Shah JB, Achim M. Robot-assisted extended pelvic lymph node dissection (PLND) at the time of radical prostatectomy (RP): a video-based illustration of technique, results, and unmet patient selection needs. BJU Int. 2011;108:993–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Briganti A, Chun FK, Salonia A, Suardi N, Gallina A, Da Pozzo LF, et al. Complications and other surgical outcomes associated with extended pelvic lymphadenectomy in men with localized prostate cancer. Eur Urol. 2006;50:1006–13.CrossRefPubMedGoogle Scholar
  23. 23.
    Joniau S, Van den Bergh L, Lerut E, Deroose CM, Haustermans K, Oyen R, et al. Mapping of pelvic lymph node metastases in prostate cancer. Eur Urol. 2013;63:450–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Kim KH, Lim SK, Kim HY, Shin TY, Lee JY, Choi YD, et al. Extended vs standard lymph node dissection in robot-assisted radical prostatectomy for intermediate- or high-risk prostate cancer: a propensity-score-matching analysis. BJU Int. 2013;112:216–23.CrossRefPubMedGoogle Scholar
  25. 25.
    Tyritzis SI, Wallerstedt A, Steineck G, Nyberg T, Hugosson J, Bjartell A, et al. Thromboembolic complications in 3,544 patients undergoing radical prostatectomy with or without lymph node dissection. J Urol. 2015;193:117–25.CrossRefPubMedGoogle Scholar
  26. 26.
    Koie T, Yamamoto H, Hatakeyama S, Kudoh S, Yoneyama T, Hashimoto Y, et al. Minimum incision endoscopic radical prostatectomy: clinical and oncological outcomes at a single institute. Eur J Surg Oncol. 2011;37:805–10.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Takuma Narita
    • 1
  • Takuya Koie
    • 1
    Email author
  • Teppei Ookubo
    • 2
  • Koji Mitsuzuka
    • 2
  • Shintaro Narita
    • 3
  • Hayato Yamamoto
    • 1
  • Takamitsu Inoue
    • 3
  • Shingo Hatakeyama
    • 1
  • Sadafumi Kawamura
    • 4
  • Tatsuo Tochigi
    • 4
  • Tomonori Habuchi
    • 3
  • Yoichi Arai
    • 2
  • Chikara Ohyama
    • 1
  1. 1.Department of UrologyHirosaki University Graduate School of MedicineHirosakiJapan
  2. 2.Department of UrologyTohoku University Graduate School of MedicineSendaiJapan
  3. 3.Department of UrologyAkita University Graduate School of MedicineAkitaJapan
  4. 4.Department of UrologyMiyagi Cancer CenterNatoriJapan

Personalised recommendations