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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

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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.

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Authors and Affiliations

  1. Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, 036-8562, Japan

    Takuma Narita, Takuya Koie, Hayato Yamamoto, Shingo Hatakeyama & Chikara Ohyama

  2. Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan

    Teppei Ookubo, Koji Mitsuzuka & Yoichi Arai

  3. Department of Urology, Akita University Graduate School of Medicine, Akita, Japan

    Shintaro Narita, Takamitsu Inoue & Tomonori Habuchi

  4. Department of Urology, Miyagi Cancer Center, Natori, Japan

    Sadafumi Kawamura & Tatsuo Tochigi

Authors
  1. Takuma Narita
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  2. Takuya Koie
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  3. Teppei Ookubo
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  4. Koji Mitsuzuka
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  5. Shintaro Narita
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  7. Takamitsu Inoue
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  8. Shingo Hatakeyama
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  9. Sadafumi Kawamura
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  11. Tomonori Habuchi
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  13. Chikara Ohyama
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Correspondence to Takuya Koie.

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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.

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Narita, T., Koie, T., Ookubo, T. et al. 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. Med Oncol 34, 1 (2017). https://doi.org/10.1007/s12032-016-0859-0

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  • DOI: https://doi.org/10.1007/s12032-016-0859-0

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