Pelvic Lymphadenectomy May Not Improve Biochemical Recurrence-Free Survival in Patients with Prostate Cancer Treated with Robot-Assisted Radical Prostatectomy in Japan (The MSUG94 Group)

Abstract

In this multicenter retrospective cohort study, we aimed to evaluate whether pelvic lymph node dissection (PLND) improved biochemical recurrence (BCR) in patients with prostate cancer (PCa) who underwent robot-assisted radical prostatectomy (RARP) in Japan. A multicenter retrospective cohort study of 3195 PCa patients undergoing RARP at nine institutions in Japan was conducted. Enrolled patients were divided into two groups: those who underwent RARP without PLND (non-PLND group) and those who underwent PLND (PLND group). The primary endpoint was biochemical recurrence-free survival (BRFS) in PCa patients who underwent PLND. We developed a propensity score analysis to reduce the effects of selection bias and potential confounding factors. Propensity score matching resulted in 1210 patients being enrolled in the study. The 2-year BRFS rate was 95.0% for all patients, 95.8% for the non-PLND group, and 94.3% for the PLND group (p = 0.855). For the all-risk group according to the National Comprehensive Cancer Network risk stratification, there were no significant differences between patients who did and did not undergo PLND. Based on the results of the log-rank study, PLND may be unnecessary for patients with PCa undergoing RARP.

Efficacy and Safety of Neoadjuvant Luteinizing Hormone-Releasing Hormone Antagonist and Tegafur-Uracil Chemohormonal Therapy for High-Risk Prostate Cancer

“…Multivariate Cox regression analysis showed that treatment with RT + ADT significantly reduced the risk of BCR compared to RP (hazard ratio [HR] 0.162, p < 0.001). However, there was no significant difference in the risk of local recurrence, distant metastasis, or OS between the two treatment modalities ( p = 0.470, p = 0.268, p = 0.509, respectively) [ 28 ]. Therefore, it is necessary to determine which treatment should be chosen for high-risk PCa when considering OS as an endpoint.…”

“…In a study in which PLND was associated with an improved BCR, a 2-year BRFS rate of 93% was reported in 439 patients who underwent RARP with PLND, although the median follow-up period was only 16 months [ 43 ]. According to a multicenter retrospective cohort study of 3195 patients with PCa who underwent RARP at nine institutions in Japan, the 2-year BRFS rates were 95.8% in patients who underwent RARP without PLND and 94.3% in those with PLND ( p = 0.855) [ 28 ]. In this study, the BRFS rate in the ADT + UFT group was also similar to that in the non-high-risk PCa group and the RARP + PLND group [ 28 ].…”

“…According to a multicenter retrospective cohort study of 3195 patients with PCa who underwent RARP at nine institutions in Japan, the 2-year BRFS rates were 95.8% in patients who underwent RARP without PLND and 94.3% in those with PLND ( p = 0.855) [ 28 ]. In this study, the BRFS rate in the ADT + UFT group was also similar to that in the non-high-risk PCa group and the RARP + PLND group [ 28 ]. Since this study was not a randomized controlled trial and the observation period was relatively short, the pros and cons of PLND need to be further discussed.…”

“…All patients underwent computed tomography and magnetic resonance imaging prior to RARP, confirming the absence of levator muscle invasion, locoregional and distant lymph node involvement, and distant metastases. All enrolled in the study did not undergo pelvic lymph node dissection (PLND) for the reasons we have previously reported [ 27 , 28 ].…”

Treatment Strategies for High-Risk Prostate Cancer - Utility of Combination Therapy of Neoadjuvant Therapy and Radical Prostatectomy to Improve Oncologic Outcomes

“…According to various guidelines, ePLND is strongly recommended as a surgical treatment for high-risk PCa [3,4]. However, there is currently disagreement as to whether pelvic lymph node dissection (PLND) should be performed in any patient when performing RP for PCa [34]. The benefits of ePLND include improved accuracy in precisely staging PCa [30].…”