Surgical management of lymph-node-positive prostate cancer: improves symptomatic control

Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? There is a paucity of data regarding symptomatic local progression of patients treated with radical prostatectomy in the setting of lymph-node-positive prostate cancer. Our retrospective study shows that radical prostatectomy with adjuvant hormonal therapy improves local control of patients in this cohort.

• To assess the impact of primary surgical therapy on local control for patients with lymph-node-positive prostate cancer.

• A retrospective analysis from January 1982 to January 2001 identified 192 patients treated by radical retropubic prostatectomy (RRP, N= 87), hormonal ablative therapy (ADT, N= 74), or RRP plus adjuvant hormones (RRP + ADT, N= 31). • Statistical analyses were conducted using the Kruskal-Wallis test, chi-squared or Fisher's exact test, log-rank test and logistic regression with the statistical significance level set at P < 0.05.

• The incidence of local relapse in the three treatment groups (RRP, ADT and RRP + ADT) was 40.2%, 59.5% and 12.9%, respectively. • Among those with local relapse, the incidence of symptomatic local relapse (defined as local symptoms secondary to locally recurrent prostate cancer) was 25.7%, 75.0% and 50.0%, respectively. • Logistic regression analysis used to identify predictors of local relapse indicated that patients treated with ADT (OR = 1.96; P= 0.270) had higher odds of having a local relapse whereas patients treated with RRP + ADT (OR = 0.20; P= 0.032) had significantly lower odds of having a local relapse compared with patients treated with RRP (reference group) after adjusting for other significant predictors such as increases in serum PSA at diagnosis (OR = 1.09; P= 0.018) and biochemical failure after primary therapy (OR = 48.3; P < 0.001). • Logistic regression analysis used to identify predictors of symptomatic local relapse, among patients having had a relapse, indicated that patients treated with RRP + ADT (OR = 2.90; P= 0.322) had higher odds of having a symptomatic local relapse whereas patients treated with ADT alone (OR = 8.67; P < 0.001) had significantly higher odds of having a symptomatic local relapse compared with patients treated with RRP (reference group).

• Radical prostatectomy (with adjuvant hormonal therapy) provides improved local control in patients with lymph-node-positive prostate cancer. • This important endpoint must be considered when determining the optimal treatment of patients with node-positive disease.