833 the Impact of the Extent of Lymph-Node Dissection on Biochemical Relapse After Radical Prostatectomy in Node-Negative and Node-Positive Patients: Behind the Will Rogers Phenomenon?

Schiavina, Riccardo; Franceschelli, Alessandro; Brunocilla, Eugenio; Concetti, Sergio; Garofalo, Marco; Vagnoni, Valerio; Molducci, S.; Pernetti, Remigio; Bizzarri, Cosimo Nicolo'; Baccos, Alessandro; Borgatti, F.; Manferrari, Fabio; Martorana, Giuseppe

doi:10.1016/s1569-9056(10)60816-0

Cited by 14 publications

(21 citation statements)

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“…We routinely performed obturator lymph node dissection, and internal iliac lymph node dissection was also implemented for high-risk cases by NCCN classification. Lymph node dissection in radical prostatectomy is mainly for the purpose of staging, but for advanced cases it may be therapeutic [16]. Only four instances of lymph node metastasis were found in this series of cases, and three of these four patients achieved undetectable postoperative PSA, two without BCR at 3 and 30 months, and the other two cases recurred biochemically at 25 and 47 months after surgery.…”

Section: Discussionmentioning

confidence: 86%

Improvement of the surgical curability of locally confined prostate cancer including non-organ-confined high-risk disease through retropubic radical prostatectomy with intentional wide resection

et al. 2012

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BackgroundRetropubic radical prostatectomy with intentional wide resection (RRP-WR), which enables clear location of the prostate apex and the performance of posterolateral wider resection to remove extraprostatic extension, was introduced to our institutions. The aim of this study is to assess the feasibility and the efficacy of RRP-WR as a surgical intervention for locally confined prostate cancer.MethodsA total of 90 Japanese patients with pathologically proven and clinically locally confined hormone-naïve prostate cancer were treated through RRP-WR, and the surgical morbidity was assessed. The patients were observed without immediate treatment until biochemical recurrence (BCR).ResultsThe surgical morbidities were comparable to conventional procedures. No positive surgical margin (pSM) was pathologically identified in pT2 cases from prostatectomy specimens. It was identified in only 14.3% of pT3a cases, 36.4% of pT3b cases and 100% of pT4 cases. No apical pSM was found except for one of the pT4 cases in the levator ani muscle. PSA was at an undetectable level in 80.0% of all cases, 90.0% of pT2 cases, and 67.5% of pT3 and pT4 cases after surgery. The BCR-free survival rate in all cases was 82.4% and that of high-risk cases without pSM was 76.9% at a median follow-up of 19.3 months (3.3 to 59.2).ConclusionsRRP-WR is feasible and effective in removing organ-confined prostate cancer as well as extraprostatic extension without pSM. Thus, it is worthwhile to evaluate if this procedure improves the clinical outcome of locally confined prostate cancer including high-risk conditions treated by surgical intervention.

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Section: Discussionmentioning

confidence: 86%

Improvement of the surgical curability of locally confined prostate cancer including non-organ-confined high-risk disease through retropubic radical prostatectomy with intentional wide resection

et al. 2012

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“…The remaining four [19][20][21][22] studies from the total of sixteen used the number of lymph nodes removed as a surrogate for the extent of dis section and were deemed to have a suitable format for inclusion in the review.…”

Section: Resultsmentioning

confidence: 99%

“…Similarly, Schiavina et al [21] found that in node negative patients, those with 10 or greater nodes removed had improved BCRFS than those with less taken (HR 0.564, CI 0.390-0.814, p=0.002). Another paper from the same author and institution [22] looking at intermediate and high-risk groups found that 10 or greater nodes removed was associated with a benefit to BCRFS rates at 10 years here too (58.5% vs. 46.4%, p=0.023).…”

Section: Lplnd Vs Eplndmentioning

confidence: 86%

“…Its findings are also at odds with the other papers using similar methods. Joslyn and Konety [19] and the two papers from Schiavina et al [21,22] also used the surrogate measure for dissection extent but did find an improvement in outcomes. They also both found particular improvement in patients who had minimal positive nodal involvement, which was echoed in Allaf et al [15] and the follow up to this paper.…”

Section: Discussionmentioning

confidence: 99%

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Is extended pelvic lymph node dissection for prostate cancer the only recommended option? A systematic over-view of the literature

Rees

Raison

Sheikh

et al. 2016

Turkish Journal of Urology

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Objective: Pelvic lymph node dissection (PLND) is performed alongside radical prostatectomy as the most accurate method of staging prostate cancer. Yet the potential therapeutic benefits of lymphadenectomy are yet to be confirmed. Material and methods:A PubMed database search was performed to identify all papers comparing techniques for PLND or none. The primary outcome measure was long term oncological outcomes. Studies looking at men with clinically localized prostate cancer at the time of radical prostatectomy who received no adjuvant treatment were included. Previous reviews and single case reports were excluded. The subsequent available papers were then systematically reviewed.

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“…In a recent study of 614 men by Schiavina et al . [76] in 2010, those who had ≥10 LNs removed had better biochemical relapse‐free survival compared with those had fewer LNs removed. Masterson et al .…”

Section: Role Of Ln Therapy In High‐risk Prostate Cancermentioning

confidence: 99%

The role of surgery in high‐risk localised prostate cancer

et al. 2011

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The optimal management of high‐risk localised prostate cancer is a major challenge for urologists and oncologists. It is clear that multimodal therapy including radical local treatment is needed in these men to achieve the best outcomes. External beam radiotherapy (EBRT) is an essential component of therapy either as a primary or adjuvant treatment. However, the role of radical prostatectomy (RP) is more controversial. Both methods are currently valid therapy options. There have been many individual studies of EBRT and RP in high‐risk disease, but no good quality large prospective randomized trials. In EBRT, combination with neoadjuvant plus long‐term adjuvant androgen‐deprivation therapy (ADT) has been conclusively shown to improve outcomes and is widely considered the standard of care. However, the role of RP has achieved recent prominence with several important studies. Published data from prospective randomized trials in patients after RP have shown that in men with adverse pathological features at surgery, the addition of adjuvant RT improves biochemical‐free and progression‐free survival. More recently, studies from large‐volume centres comparing EBRT and RP have provided intriguing suggestions of better outcomes with RP as the primary treatment. An important question therefore, is which of the two methods provides the best outcome in men with localised high‐risk disease. Crucially, does the combination of RP and selective adjuvant EBRT provide clinically significant better outcomes compared with EBRT alone? In this review we discuss the current evidence for the role of RP for high‐risk localised prostate cancer and define the parameters and urgent need for a prospective trial to test the role of surgery for this group of patients.

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833 the Impact of the Extent of Lymph-Node Dissection on Biochemical Relapse After Radical Prostatectomy in Node-Negative and Node-Positive Patients: Behind the Will Rogers Phenomenon?

Cited by 14 publications

References 0 publications

Improvement of the surgical curability of locally confined prostate cancer including non-organ-confined high-risk disease through retropubic radical prostatectomy with intentional wide resection

Improvement of the surgical curability of locally confined prostate cancer including non-organ-confined high-risk disease through retropubic radical prostatectomy with intentional wide resection

Is extended pelvic lymph node dissection for prostate cancer the only recommended option? A systematic over-view of the literature

The role of surgery in high‐risk localised prostate cancer

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