Removal of greater number of lymph nodes during RP associated with better survival

[Graham49]

Removal of greater numbers of lymph nodes during radical prostatectomy for intermediate- and high-risk prostate cancer is associated with improved survival, according to data presented at the 22nd annual meeting of the Society of Urologic Oncology.

In a propensity score analysis, removal of 10 to 19 lymph nodes was significantly associated with a 14% decreased risk for death compared with removal of less than 10 lymph nodes among patients with intermediate-risk prostate cancer, Furkan Dursun, MD, of the University of Texas Health San Antonio, reported on behalf of his research team. Removal of 20 or more lymph nodes was significantly associated with a 39% decreased risk for death among patients with high-risk prostate cancer.

The study included 103,250 patients identified using the National Cancer Database. Of these, 74.2% and 25.8% had intermediate- and high-risk prostate cancer. The number of excised lymph nodes was less than 10 for 80.5% of patients, 10 to 19 for 15.9%, and 20 or more for 3.6%.

In both the intermediate- and high-risk groups, pathologically proven lymph node-positive disease rates were significantly higher among patients with 20 or more excised lymph nodes compared with those who had fewer than 10 and 10-19 excised lymph nodes (9.25% vs 1.53% and 4.45% for intermediate-risk patients and 25.25% vs 5.65% and 15.53%, respectively, for high-risk patients).

Dr Dursun and colleagues defined intermediate-risk prostate cancer as cT2b-2c and/or PSA level 10-20 ng/mL and/or Grade Group 2 or 3 disease and high-risk prostate cancer as cT3 or higher and/or PSA level greater than 20 ng/mL, and/or Grade Group 4 or 5.

Reference

Dursun F, Elshabrawy A, Wang H, et al. Impact of extent of lymphadenectomy on all-cause mortality in patients with intermediate- and high-risk prostate cancer managed with radical prostatectomy. Presented at 22nd annual meeting of the Society of Urologic Oncology, December 1-3, 2021. Poster 143.

[cesanon]

Those lymph nodes must be doing something.

What is the adverse impact when they are removed?

[Bkraus1]

This is a good article, thank you for sharing. I think that it would be helpful to have a PSMA scan before surgery so that the surgeon can target or remove the involved lymph node. This would lead to a greater role for surgery. Essentially today the surgeon just removes nodes randomly during RP and nothing is targeted.

[cesanon]

You had lymph nodes surgically removed?

When I asked my Doc about that he said mine were located in a surgically difficult to reach area (If I recollect they were on or near the Iliac)

[Justfor_]

In Europe this is business as usual. I am high-risk and had 20 LN removed.

[Bkraus1]

No urologic surgeon knows the pattern of lymph node involvement with prostate cancer. Studies on sentinel lymph node assays have proven this. Lymph node sampling is just random process today.

[Explorer08]

Lymphedema is the risk with lymph node removal. Fairly common in cancer patients and can take several years to manifest itself.

[Explorer08]

Exactly correct!

[pjoshea13]

When I met Dr. Myers briefly in 2004, he was a few months away from 5-year survival. He said that he had almost every lymph node in his body removed. & added: "I don't suppose they would do that today." Mind you, he didn't look well then, IMO. Not like the man we see in his vlog posts.

-Patrick