BERKELEY, CA (UroToday.com) - Treatment of lymph-node-positive prostate cancer has usually been relegated to the area of non-curative intent.
It has been shown, however, that many of these patients will need procedures to alleviate obstruction of the upper and lower urinary tract, as well as interventions for bleeding and pain secondary to local progression. Our study indicates that those patients found to have involved lymph nodes at the time of prostatectomy have a lower rate of local symptoms that those patients who are closed up and given hormones alone. It may also be that performing radical prostatectomy in this cohort of patients may improve survival. Indeed, long-term PSA-free survival has been shown. Especially when combining surgery with ADT, there appears to be a significant advantage in terms of overall and recurrence-free survival.
While our study is indicative of a significant difference, it is a retrospective case series and thus has all of the drawbacks associated with this type of evidence. What is needed in the future is a prospective trial of patients found to have lymph-node positive disease at the time of prostatectomy to either undergo prostatectomy or not. In this era however, more and more surgeons are forgoing lymphadenectomy as the selection criteria are becoming stricter. It may be that patients with radiographic evidence of lymph-node metastasis will be the next cohort to be studied.
Written by:
Philippe E. Spiess, MD, MS, FACS and Lucas R. Wiegand, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Surgical management of lymph-node-positive prostate cancer: improves symptomatic control - Abstract
UroToday.com Prostate Cancer Section
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