Two Positive Nodes Represent a Significant Cut-Off Value for Cancer Specific Survival in Patients With Node Positive Prostate Cancer. A New Proposal Based on a Two Institution Experience on 784 Consecutive N+ Patients

More extended lymph node dissection template at radical prostatectomy detects metastases in the common iliac region and in the fossa of Marcille

“…In the historical cohort, 80 patients ( (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) in the historical cohort and 34 (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42) in the contemporary cohort (P < 0.001). In the contemporary cohort, the median (IQR) number of LNs removed in the common iliac regions was 4 (2-6) and 4.5 (3)(4)(5)(6)(7) in the fossa of Marcille.…”

“…Because there may be oncological benefit for patients with low-volume nodal disease or negative LNs [1][2][3][4][5][12][13][14][15], our institution uses an extended PLND whenever RP is indicated.…”

“…A similar model was constructed to evaluate the risk of biochemical recurrence within 3 years, defined as PSA ≥0.2 ng/mL in two consecutive measurements. Finally, sub-analysis of patients with ≤2 LN metastases was performed because these patients may be the ones who would most benefit from removal of LN metastases [1][2][3][4][5]. Calculations were performed using IBM SPSS 23 (IBM, Armonk, NY, USA).…”

“…Single-centre experience suggests that patients with minimal lymph node (LN) disease (defined as only one or two LN metastases at radical prostatectomy [RP] and pelvic LN dissection [PLND]) may not progress for up to 15 years if these LNs are removed, even without adjuvant therapy [1][2][3][4][5]. These results would not seem possible if metastatic LNs had been left in, suggesting that for these patients each positive LN should be found and removed.…”

Developments in External Beam Radiotherapy for Prostate Cancer

“…Additionally, the standard treatment with ADT was recently challenged by the observation that a subset of PC patients develop metastases in limited numbers (termed oligometastases) and that survival and response to ADT varies as a function of the number of metastases. [56][57][58][59] It is hypothesized that local treatment of limited metastases, with surgery or radiotherapy, might delay the start of potentially toxic systemic treatments. 59 Moreover, patients with an initial low-volume metastatic disease were more likely to progress locally during ADT instead of distant, while the opposite was true for patients with highvolume metastatic disease.…”