Parameters associated with patient outcomes in lymph node positive prostate cancer

Dr. Hofer and colleagues report in the June issue of Urology that lymphovascular invasion (LVI) and the nuclear grade of the primary prostate tumor are independent predictors of PSA recurrence in men with lymph node positive CaP.

The retrospective study included 119 eligible men with lymph node positive CaP who underwent radical prostatectomy at the University of Ulm Hospital, Germany. Clinical and pathologic examination was performed.

The mean number of lymph nodes removed was 12 and the mean number positive was 3. Almost 50% of men had only 1 positive node, 22% had 2 and 34% had more than 2 positive nodes. PSA failure occurred n 41% of these men, leaving 59% free of disease with a mean follow-up of 41 months. The 5-year PSA failure-free survival rate was 61% and the mean PSA failure-free survival time was 54 months.

The metastatic growth pattern in the lymph nodes was similar to the architectural growth pattern used for grading the primary tumor. Extra-nodal extension was seen in 55% of the cases, and 25% had lymph nodes with LVI.

Pre-operative PSAS was not predictive of a PSA failure. However, multivariable analysis demonstrated that LVI of the metastasis and nuclear tumor grade were associated with PSA recurrence. These pathologic parameters may help to identify patients at risk for disease recurrence and direct them towards adjuvant therapies and clinical trials.

By Christopher P. Evans, MD

Reference:

Urol 2006;67:1016-1021

http://www.ncbi.nlm.nih.gov/entrez/

Hofer MD, Kuefer R, Huang W, Li H, Bismar TA, Perner S, Hautmann RE, Sanda MG, Gschwend JE, Rubin MA

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