Date Published: October 3, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Wolfgang Otto, Peter Gerber, Wolfgang Rößler, Wolf F. Wieland, Stefan Denzinger.
Introduction. Suspected locally advanced prostate carcinoma shows lymph node involvement in a high percentage of cases. For a long time, such patients were not radically prostatectomised. In recent years, however, this viewpoint has changed. Material and Methods. We analysed a single-centre series of 34 patients with suspected locally advanced prostate cancer to establish predictive parameters for lymph node metastasis. All patients underwent radical prostatectomy between 2007 and 2010. Results. Of the 34 patients, 26% showed pathological stage T3a, 59% pT3b, and 15% pT4. Median preoperative PSA level was 25 ng/mL, and five patients had had neoadjuvant antihormonal treatment. Positive margins were found in 76% of patients. Patients without neoadjuvant treatment showed it in 79%, and after preoperative antihormonal treatment the rate was 60%. Positive margins were associated with lymph node involvement in 85% of cases, complete resection was associated only in 50% of cases. Conclusions. Positive surgical margins play an important predictive role when estimating lymph node involvement in patients with locally advanced prostate carcinoma. Neoadjuvant antihormonal therapy is associated with a relevant reduction in the rate of positive margins but not with the rate of lymph node metastasis. As such, a combination of antihormonal and surgical treatment should be considered.
According to the European Association of Urology (EAU) guidelines on prostate carcinoma, radical prostatectomy (RP) is the standard treatment for stage T2N0M0 prostate cancer, equivalent to radiation therapy. For locally advanced prostate cancer, recommendations are less concise. In selected patients RP in combination with extended pelvic lymphadenectomy may be feasible. A study by Gontero et al. showed no relevant differences in the rate of comorbidities, only transfusion and lymphocele rate appeared more often compared to T2N0M0 prostate carcinoma. Cancer-specific survival (CSS) was 90% for T3-4, N0, M0 prostate cancer, and 99% for organ-confined cancer .
We retrospectively collected clinical and histopathological data of 34 patients who underwent RP for suspected ≥cT3 prostate cancer. Open surgery took place between 2007 and 2010 in a German single centre.
Alongside the Gleason score and pathological T stage, the presence of positive surgical margins is an important predictive factor in estimating lymph node involvement. Neoadjuvant antihormonal therapy does lead to a relevant reduction in the rate of positive margins, but not to a reduction in the rate of lymph node metastasis. As such, antihormonal and surgical treatment should be considered in combination for the therapy of locally advanced prostate cancer.