Risk of prostate carcinoma death in patients with lymph node metastasis

BACKGROUND. The presence of lymph node metastasis is a poor prognostic sign for patients with prostate carcinoma. Results of published reports on surv ival among patients with lymph node metastasis are difficult to assess beca use of treatment selections. The extent to which lymph node status will hav e an impact on a patient's survival is uncertain. METHODS. The authors analyzed 3463 consecutive Mayo Clinic patients who und erwent radical prostatectomy and bilateral pelvic lymphadenectomy for prost ate carcinoma between 1987 and 1993. Of these patients, 322 had lymph node metastasis at the time of surgery, and 297 lymph node positive patients als o received adjuvant hormonal therapy within 90 days of surgery. The progres sion free rate and the cancer specific survival rate were used as outcome e ndpoints in univariate and multivariate Cos proportional hazards models. Th e median follow-up was 6.3 years. Progression was defined by elevation of s erum prostate specific antigen (PSA) greater than or equal to 0.4 ng/mL aft er surgery, development of local recurrence, or distant metastasis document ed by biopsy or radiographic examination. RESULTS. The 5-year and 10-year progression free survival rates (+/- standa rd error [SE]) for patients with lymph node metastasis were 74% +/- 2% and 64% +/- 3%, respectively, compared with 77% +/- 1% and 59% +/- 2%, respecti vely, for patients ir without lymph node metastasis. The 5-year and 10-year cancer specific survival rates were 94% +/- 1% and 83% +/- 4%, respectivel y, compared with 99% +/- 0.1% and 97% +/- 0.5%, respectively for patients w ithout lymph node metastasis. Among patients with a single lymph node metas tasis, the 5-year and 10-year cancer specific survival rates were 99% +/- 1 5 and 94% +/- 3%, respectively. After adjustment for extraprostatic extensi on seminal vesicle invasion, Gleason grade, surgical margins, DNA ploidy, p reoperative serum PSA concentration and adjuvant therapy, the hazard ratio for death from prostate carcinoma among patients with a single lymph node m etastasis compared with patients who were without lymph node metastasis was 1.5 (95% confidence interval, 0.5-5.0; P = 0.478), whereas the hazard rati o for death from prostate carcinoma was 6.1 (95% confidence interval, 1.9-1 9.6; P = 0.002) for those with two positive lymph nodes and 4.3 (95% confid ence interval, 1.4-13.0; P = 0.009) for those with three or more positive l ymph nodes. There was no significant difference in tile progression free su rvival rate among patients with or without lymph node metastasis in multiva riate analysis after controlling for all relevant variables, including trea tments (hazard ratio,1.0; 95% CI, 0.7-1.3; P = 0.90). CONCLUSIONS. Patients with prostate carcinoma who have multiple regional ly mph node metastases had increased risk of death from disease, whereas patie nts with single lymph node involvement appeared to have a more favorable pr ognosis after radical prostatectomy and immediate adjuvant hormonal therapy . Excellent local disease control was achieved by using combined surgery an d adjuvant hormonal therapy in patients with positive lymph nodes.