DOES RADICAL PROSTATECTOMY IN THE PRESENCE OF POSITIVE PELVIC LYMPH-NODES ENHANCE SURVIVAL

A retrospective review was performed on all patients with stage D1 pro state cancer treated at Duke University Medical Center between 1975 an d 1989. A total of 156 patients underwent staging pelvic lymph-node di ssection for clinically organ-confined prostate cancer (stage A or B) but were found to have disease metastatic to the pelvic lymph nodes (s tage D1). Of this population, 42 patients also underwent radical prost atectomy (group 1), leaving 114 who did not have their prostate remove d (group 2). The median cancer-specific survival was 11.2 years for gr oup 1 versus 5.8 years for group 2 (P = 0.005). In patients with one o r two positive lymph nodes the median cancer-specific survival was 10. 2 years for group 1 versus 5.9 years for group 2 (P = 0.015). There wa s no difference in survival if three or more lymph nodes were positive . Adjuvant treatment with immediate androgen deprivation and/or postop erative radiation therapy failed to improve the survival experience. T he incidence of local problems, including stricture formation, bleedin g, or regrowth of cancer requiring dilation or surgical intervention ( transurethral prostatectomy) averaged 9.5% in group 1 and 24.6% in gro up 2. These data show that patients with limited node-positive disease selected for radical prostatectomy experience a survival advantage ov er those denied such therapy and that this advantage is independent of adjunctive therapy.