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. 2022 Jan 1;32(1):69-84.
doi: 10.1097/MOU.0000000000000946.

Features and management of men with pN1 cM0 prostate cancer after radical prostatectomy and lymphadenectomy: a systematic review of population-based evidence

Charles Laine  1 , Giorgio Gandaglia  2 , Massimo Valerio  3 , Isabel Heidegger  4 , Igor Tsaur  5 , Jonathan Olivier  6 , Francesco Ceci  7 , Roderick C N van den Bergh  8 , Alexander Kretschmer  9 , Constance Thibault  10 , Peter K Chiu  11 , Derya Tilki  12 , Veeru Kasivisvanathan  13 , Felix Preisser  14 , Fabio Zattoni  15 , Christian Fankhauser  16 , Claudia Kesch  17 , Ignacio Puche-Sanz  18 , Marco Moschini  2 , Benjamin Pradere  19 , Guillaume Ploussard  20 , Giancarlo Marra  1   21   22 ; EAU-YAU Prostate Cancer Working Party
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Free article

Features and management of men with pN1 cM0 prostate cancer after radical prostatectomy and lymphadenectomy: a systematic review of population-based evidence

Charles Laine et al. Curr Opin Urol. .
Free article

Abstract

Purpose of review: To investigate the features and optimal management of pN+ cM0 prostate cancer (PCa) according to registry-based studies.

Recent findings: Up to 15% of PCa patients harbor lymph node invasion (pN+) at radical prostatectomy plus lymph node dissection. Nonetheless, the optimal management strategy in this setting is not well characterized.

Summary: We performed a systematic review including n = 13 studies. Management strategies comprised 13 536 men undergoing observation, 11 149 adjuvant androgen deprivation therapy (aADT), 7,075 adjuvant radiotherapy (aRT) +aADT and 705 aRT. Baseline features showed aggressive PCa in the majority of men. At a median follow-up ranging 48-134months, Cancer-related death was 5% and overall-mortality 16.6%. aADT and aRT alone had no cancer-specific survival or overall survival advantages over observation only and over not performing aRT, respectively. aADT plus aRT yielded a survival benefit compared to observation and aADT, which in one study, were limited to certain intermediate-risk categories. Age, Gleason, Charlson score, positive surgical margins, pathological stage, and positive nodes number, but not prostate specific antigen, were most relevant prognostic factors. Our work further confirmed pN+ PCa is a multifaceted disease and will help future research in defining its optimal management based on different risk categories to maximize survival and patient's quality of life.

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References

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