Temporal Trends and Predictors in Diagnosing Pathologic Node-Positive Prostate Cancer in Clinically Node-Negative...

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• Managing pathologically node positive (pN+) prostate cancer (PCa) in clinically node negative (cN-) patients remains controversial.
• Temporal trends and predictors of pN+ PCa in cN- patients undergoing initial surgical management require further elucidation.

Purpose of the Study:

• To describe temporal patterns in the diagnosis of pN+ prostate cancer (PCa) among men initially staged as clinically node negative (cN-).
• To identify predictors of pN+ PCa in this cohort.
• To evaluate the impact of pelvic lymph node dissection (PLND) on survival in pN+ patients.

Main Methods:

• Retrospective analysis of nonmetastatic, cN- prostate cancer (PCa) cases from the National Cancer Database.
• Multivariable logistic regression to identify covariates associated with pN+ disease.
• Cox proportional hazards modeling and Kaplan-Meier analysis to assess survival outcomes in patients undergoing radical prostatectomy with or without pelvic lymph node dissection (PLND).

Main Results:

• The incidence of pN+ prostate cancer (PCa) has increased over time in clinically node negative (cN-) men.
• High-grade disease, specifically International Society of Urological Pathology (ISUP) Grade Group 4 (GG4) and GG5, are the strongest predictors of pN+ disease.
• Patients with GG4 and GG5 prostate cancer (PCa) undergoing pelvic lymph node dissection (PLND) demonstrated superior survival compared to those without PLND.

Conclusions:

• The diagnosis of pathologically node positive (pN+) prostate cancer (PCa) is becoming more frequent in clinically node negative (cN-) patients.
• ISUP Grade Group 4 (GG4) and GG5 are significant predictors of pN+ disease, leading to upstaging.
• These findings aid in pre-operative counseling for radical prostatectomy, particularly for patients with high-grade tumors.