MP53-16 LONG-TERM ONCOLOGIC OUTCOMES OF ADDING RADICAL PROSTATECTOMY TO CASTRATION FOR PATHOLOGICAL NODE-POSITIVE PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) III1 Apr 2017MP53-16 LONG-TERM ONCOLOGIC OUTCOMES OF ADDING RADICAL PROSTATECTOMY TO CASTRATION FOR PATHOLOGICAL NODE-POSITIVE PROSTATE CANCER Bimal Bhindi, Laureano Rangel, Ross Mason, Matthey Gettman, Igor Frank, Eugene Kwon, Matthew Tollefson, R. Houston Thompson, Stephen Boorjian, and R. Jeffrey Karnes Bimal BhindiBimal Bhindi More articles by this author , Laureano RangelLaureano Rangel More articles by this author , Ross MasonRoss Mason More articles by this author , Matthey GettmanMatthey Gettman More articles by this author , Igor FrankIgor Frank More articles by this author , Eugene KwonEugene Kwon More articles by this author , Matthew TollefsonMatthew Tollefson More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , Stephen BoorjianStephen Boorjian More articles by this author , and R. Jeffrey KarnesR. Jeffrey Karnes More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1667AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Long-term data on the outcomes of aggressive loco-regional surgical resection in prostate cancer (PCa) with nodal involvement are lacking. The present study reports on the impact of adding radical retropubic prostatectomy (RRP) to surgical castration on long-term cancer-specific (CSS) and overall survival (OS) outcomes in men with pathological node-positive (pN+) PCa. METHODS Men with pN+ PCa who underwent pelvic lymphadenectomy and early bilateral orchiectomy (within 90 days of surgery), with (n=382) or without (n=79) RRP, were identified (1966-1995). Men who underwent RRP + orchiectomy and men who underwent orchiectomy alone were matched 1:1 on age, year of surgery, clinical grade, clinical stage, number of positive nodes, and pre-operative serum PSA level (after 1987). Kaplan-Meier and Cox regression analyses were used to compare CSS and OS between groups. RESULTS The cohort included 158 men (79 in each group) with a mean age of 66 years (SD=6), of whom 146 (92%) were followed until death. Groups were balanced on all matched parameters. Among men undergoing orchiectomy alone, 76 died, with 60 dying from PCa. Among patients undergoing RRP + orchiectomy, 70 died, with 28 dying from PCa. On Kaplan-Meier analyses, RRP + orchiectomy versus orchiectomy alone was associated with significantly improved CSS at 10 years (79% vs. 35%) and 20 years (59% vs. 18%) (log-rank p<0.001). Likewise, RRP + orchiectomy versus orchiectomy alone was also associated with prolonged OS at 10 years (66% vs 27%) and 20 years (22% vs. 9%)(log-rank p<0.001). In Cox models, RRP + orchiectomy versus orchiectomy alone was associated with significantly improved CSS (HR=0.28, 95%CI=0.17-0.46, p<0.001) and OS (HR=0.48, 95%CI=0.34-0.66, p<0.001). Findings were similar in the subset with available pre-operative PSA (CSS: HR=0.31, 95%CI=0.16-0.61, p<0.001; OS: HR=0.45, 95%CI=0.26-0.77, p=0.004). CONCLUSIONS With nearly the entire cohort having lifelong follow up, this analysis demonstrates that the addition of RRP to surgical castration for pN+ PCa is associated with improved CSS and OS. When technically feasible in well-selected patients, aggressive loco-regional resection should be considered in node-positive PCa as a part of a multi-modal approach. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e719-e720 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Bimal Bhindi More articles by this author Laureano Rangel More articles by this author Ross Mason More articles by this author Matthey Gettman More articles by this author Igor Frank More articles by this author Eugene Kwon More articles by this author Matthew Tollefson More articles by this author R. Houston Thompson More articles by this author Stephen Boorjian More articles by this author R. Jeffrey Karnes More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...