More Extensive Lymph Node Dissection at Radical Prostatectomy is Associated with Improved Outcomes with Salvage Radiotherapy for Rising Prostate-specific Antigen After Surgery: A Long-term, Multi-institutional Analysis

Nicola Fossati, William P. Parker, R. Jeffrey Karnes, Michele Colicchia, Alberto Bossi, Thomas Seisen, Nadia Di Muzio, Cesare Cozzarini, Barbara Noris Chiorda, Claudio Fiorino, Giorgio Gandaglia, Detlef Bartkowiak, Thomas Wiegel, Shahrokh Shariat, Gregor Goldner, Antonino Battaglia, Steven Joniau, Karin Haustermans, Gert De Meerleer, Valérie FonteynePiet Ost, Hein Van Poppel, Francesco Montorsi, Alberto Briganti, Stephen A. Boorjian

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Up to 50% of patients recur after salvage radiation therapy (sRT) for prostate-specific antigen (PSA) rise following radical prostatectomy (RP). Notably, the importance of lymph node dissection (LND) at the time of RP with regard to recurrence risk following sRT has not been previously determined. Therefore, we evaluated the association between nodal yield at RP and recurrence after sRT. We performed a multi-institutional review of men with a rising PSA after RP treated with sRT. Clinicopathologic variables were abstracted, and the associations between lymph node yield and biochemical (BCR) as well as clinical recurrence (CR) after sRT were assessed using multivariable Cox proportional hazards regression models. In total, 728 patients were identified; of these, 221 and 116 were diagnosed with BCR and CR, respectively, during a median follow-up of 8.4 (interquartile range: 4.2–11.2) yr. On multivariable analysis, the risk of BCR after sRT was inversely associated with the number of nodes resected at RP (hazards ratio [HR]: 0.98; 95% confidence interval [CI]: 0.96–0.99; p = 0.049). Increased extent of dissection was also independently associated with a decreased risk of CR after sRT (HR: 0.97; 95%CI: 0.94–0.99; p = 0.042). These data support the importance of an extensive LND at surgery and may be used in prognosis assessment when sRT is being considered. Patient summary: We found that patients who had increased number of lymph nodes resected at surgery had improved outcomes after the receipt of salvage radiation therapy. These findings support the use of the extended lymph node dissection at initial surgery and should serve to improve counseling among patients who require salvage radiation therapy.

Original languageEnglish (US)
Pages (from-to)134-137
Number of pages4
JournalEuropean urology
Volume74
Issue number2
DOIs
StatePublished - Aug 2018

Keywords

  • Lymph node dissection
  • Prostate cancer
  • Salvage radiation
  • Survival

ASJC Scopus subject areas

  • Urology

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    Fossati, N., Parker, W. P., Karnes, R. J., Colicchia, M., Bossi, A., Seisen, T., Di Muzio, N., Cozzarini, C., Noris Chiorda, B., Fiorino, C., Gandaglia, G., Bartkowiak, D., Wiegel, T., Shariat, S., Goldner, G., Battaglia, A., Joniau, S., Haustermans, K., De Meerleer, G., ... Boorjian, S. A. (2018). More Extensive Lymph Node Dissection at Radical Prostatectomy is Associated with Improved Outcomes with Salvage Radiotherapy for Rising Prostate-specific Antigen After Surgery: A Long-term, Multi-institutional Analysis. European urology, 74(2), 134-137. https://doi.org/10.1016/j.eururo.2018.02.024