Pathologically Node-Positive Prostate Carcinoma – Prevalence, Pattern of Care and Outcome From a Population-Based Study

Roy, Soumyajit; Sia, Michael; Tyldesley, Scott; Bahl, Gaurav

doi:10.1016/j.clon.2018.10.005

Cited by 7 publications

(10 citation statements)

References 23 publications

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“…The presence of nodal metastases diagnosed at the time of prostatectomy and PLND is generally regarded as an unfavourable prognostic feature . However, the clinical course of node‐positive patients can be variable, with some showing long‐term survival . This has prompted interest in assessing a variety of lymph node parameters to determine which features can identify the patients most likely to have adverse oncological outcomes and requiring treatment intensification.…”

Section: Discussionmentioning

confidence: 99%

“…4,5,27 However, the clinical course of node-positive patients can be variable, with some showing long-term survival. [28][29][30] This has prompted interest in assessing a variety of lymph node parameters to determine which features can identify the patients most likely to have adverse oncological outcomes and requiring treatment intensification. The relevant histological features that have been reported in the literature include number of positive lymph nodes, nodal cancer volume (using size of metastatic deposits) and the presence of ENE.…”

Section: Discussionmentioning

confidence: 99%

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Gleason grade patterns in nodal metastasis and corresponding prostatectomy specimens: impact on patient outcome

Downes

Kwast

2019

Histopathology

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Aims Lymph node metastases at the time of prostatectomy are an infrequent finding. The correlation of the pattern of nodal metastases with patient outcome has yet to be explored. Methods and results Lymph node‐positive prostatectomies were retrospectively reviewed. The presence of cribriform carcinoma (CC), intraductal carcinoma (IDC) and ISUP grade (G) were documented. The largest nodal metastasis was assessed for the morphological patterns present. G was assigned to the metastasis based on percentage morphological patterns present. Statistical analysis used spss to assess disease‐specific survival (DSS), disease‐free survival (DFS) and distant metastasis‐free survival (DMFS). One hundred and ten cases were identified: G5 (n = 52), G4 (n = 8), G3 (n = 34), G2 (n = 10) and no G (n = 6; treatment effect). IDC or CC was present in 103 (94%) specimens. More than one positive node correlated with worse DFS [P = 0.012, hazard ratio (HR) = 1.951, 95% confidence interval (CI) = 1.142–3.331] and DMFS (P = 0.009, HR = 2.647, 95% CI = 1.239–5.651). G in the prostate and nodal metastasis were poorly correlated (kappa = 0.073, P = 0.195). The presence of pattern 5 was seen in 33 nodes (30%) and correlated with DFS (P = 0.020, HR = 1.903, 95% CI = 1.091–3.320), DSS (P = 0.021, HR = 5.937, 95% CI = 1.084–32.533) and DMFS (P = 0.007, HR = 2.695, 95% CI = 1.269–5.726). Nodal cribriform pattern showed no prognostic correlation and pattern 3 metastasis showed a significant trend towards better outcome (DMFS P = 0.033, HR = 0.431, 95% CI = 0.194–0.958). Conclusions IDC or CC is identified in 94% of node‐positive prostate cancers. Although G in the largest nodal metastasis has prognostic significance, its G does not reflect that of the primary prostatic adenocarcinoma.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Gleason grade patterns in nodal metastasis and corresponding prostatectomy specimens: impact on patient outcome

Downes

Kwast

2019

Histopathology

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“…At the end of this process, nine studies remained that investigated the impact of PSA persistence on oncologic outcomes in 14,455 patients treated with RP. Those nine studies were included in this systematic review and meta-analysis [7][8][9][10][11][12][13][14][15].…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Prognostic Significance of Prostate-Specific Antigen Persistence after Radical Prostatectomy: A Systematic Review and Meta-Analysis

Kimura

Urabe

Sasaki

et al. 2021

Cancers

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We performed a systematic review and meta-analysis to assess the prognostic value of prostate-specific antigen (PSA) persistence 4–8 weeks after radical prostatectomy (RP) in patients with prostate cancer, using studies from Medline, Scopus, and Cochrane Library, on October 10, 2020. Studies were eligible if they compared patients with postoperative PSA persistence 4–8 weeks after RP to those without such persistence to assess the value of PSA persistence in prognosticating biochemical recurrence (BCR), disease recurrence, cancer-specific mortality (CSM), and overall mortality (OM) by multivariable analysis. Our review and analysis included nine studies published between 2008 and 2019 with 14,455 patients. Of those studies, 12.0% showed postoperative PSA persistence. PSA persistence was associated with BCR (HR: 4.44, 95% CI: 2.84–6.93), disease recurrence (HR: 3.43, 95% CI: 1.62–7.25), and CSM (HR: 2.32, 95% CI: 1.83–2.95). We omitted meta-analysis on the association of PSA persistence with OM due to an insufficient number of studies. PSA persistence was associated with disease recurrence in a sub-group of patients with pathological nodal involvement (HR: 5.90, 95% CI: 3.76–9.24). Understanding detection of PSA persistence at 4–8 weeks after RP might be useful for patient counseling, follow-up scheduling, and clinical decision-making regarding adjuvant therapies.

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“…Also, it should be noted that the type of surgery may vary between physicians and even institutions. Next, the duration of salvage ADT in LNP prostate cancer could be differed among different studies and the optimal duration has not yet been proven in prospective trials [3,15,27]. Finally, differences in pre-salvage PSA level between the two treatment groups may have affected treatment outcomes.…”

Section: Plos Onementioning

confidence: 99%

“…Radical prostatectomy (RP) is one of the first-line treatment option for locally advanced prostate cancer. Of all prostate cancer patients who receive RP and pelvic lymph node dissection (PLND), 3-14% have pathological lymph node-positive (LNP) disease [1][2][3]. Several previous studies showed that LNP was associated with poor prognosis in prostate cancer patients who received RP as initial treatment [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of salvage treatment in lymph node-positive prostate cancer patients after radical prostatectomy

Kim

et al. 2021

PLoS ONE

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Introduction The optimal salvage treatment strategies for lymph node-positive (LNP) patients after radical surgery have not been clearly defined in prostate cancer with biochemical recurrence or persistence of elevated prostate-specific antigen (PSA). In this study, we compared the clinical outcomes of two different salvage treatments, androgen deprivation therapy (ADT) alone versus ADT with radiotherapy (RT). We also investigated prognostic factors that could support the use of ADT with RT in LNP prostate cancer. Materials and methods We retrospectively reviewed 94 LNP prostate cancer patients who underwent radical prostatectomy (RP) followed by salvage treatment between 2004 and 2018. Salvage treatments involved either ADT alone or ADT with RT according to the clinical judgment of the physician. We analyzed clinicopathological and treatment factors related to 2nd biochemical failure (2nd BCF), clinical progression (CP), and progression-free survival (PFS). The cumulative failure after salvage treatment was defined as including both 2nd BCF and CP. Results The median duration of follow-up was 55 months (interquartile range, 35–97 months). Thirty-seven (39.4%) patients were treated with ADT alone, and 57 patients (60.6%) were treated with a combination of ADT with RT. During follow-up period, the incidence of failure after salvage treatment in the ADT alone group and the combined treatment group was 89.2% and 45.6%, respectively (HR, 22.4; 95% CI 5.43–92.1; P < 0.001). The combination of ADT with RT was associated with better 2nd BCF and PFS than ADT alone (P = 0.007 and P = 0.015, respectively). In multivariate analyses, number of positive LN ≥ 2 and PSA nadir ≥ 0.005 ng/ml after RP were associated with poor 2nd BCF, CP, and PFS after salvage treatment. Salvage by combined ADT plus RT showed better 2nd BCF and PFS than ADT alone. Specifically, patients with number of positive LN ≥ 2 or PSA nadir ≥ 0.005 ng/ml after RP showed better 2nd BCF (P = 0.004) or PFS (P = 0.011) when treated with ADT plus RT rather than ADT alone. Conclusions In patients with LNP prostate cancer, salvage ADT plus RT improved 2nd BCF and PFS compared to ADT alone. In particular, when the patients had more than two positive lymph nodes or PSA nadir ≥ 0.005 ng/ml after RP, ADT with RT seems to be a more beneficial salvage treatment resulting in better 2nd BCF and PFS.

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Pathologically Node-Positive Prostate Carcinoma – Prevalence, Pattern of Care and Outcome From a Population-Based Study

Cited by 7 publications

References 23 publications

Gleason grade patterns in nodal metastasis and corresponding prostatectomy specimens: impact on patient outcome

Gleason grade patterns in nodal metastasis and corresponding prostatectomy specimens: impact on patient outcome

Prognostic Significance of Prostate-Specific Antigen Persistence after Radical Prostatectomy: A Systematic Review and Meta-Analysis

Clinical outcomes of salvage treatment in lymph node-positive prostate cancer patients after radical prostatectomy

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