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Incidence of Lymph Node Metastasis and its Impact on Long‐term Prognosis in Clinically Localized Prostate Cancer
Author(s) -
Arai Yoichi,
Kanamaru Hiroshi,
Yoshimura Koji,
Okubo Kazutoshi,
Kamoto Toshiyuki,
Yoshida Osamu
Publication year - 1998
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/j.1442-2042.1998.tb00388.x
Subject(s) - medicine , prostatectomy , prostate cancer , lymph node , stage (stratigraphy) , radiation therapy , metastasis , dissection (medical) , cancer , incidence (geometry) , lymph , urology , oncology , surgery , pathology , paleontology , physics , biology , optics
Background: Pelvic lymph node dissection (PLND) is an important staging method for men with clinically localized prostate cancer. We report our experience with staging PLND and the impact of lymph node metastasis on long‐term prognosis. Methods: One hundred forty‐eight consecutive patients who underwent staging PLND for clinically localized prostate cancer were retrospectively studied. Patients were evaluated for the presence and number of lymph node metastases, treatment (prostatectomy vs. radiotherapy), and endocrine therapy, and analyzed with respect to disease progression and survival. The mean follow‐up period was 52.9 months (range, 2.3 to 165.8 months). Results: Thirty‐two patients (21.6%) had pelvic lymph node metastases, the incidence of which markedly decreased from 32.3% in 1982 to 1987 to 6.7% in 1994 to 1997. The intervals to disease progression and cancer death were significantly shorter in patients with positive lymph nodes ( P < 0.001). In stage D1 disease, patients who underwent a radical prostatectomy tended to be free of progression longer than those receiving radiotherapy or conservative therapy ( P = 0.0546). Other factors, such as early endocrine therapy, the extent of lymph node involvement and the Gleason score of the primary tumor did not predict disease progression or survival. Conclusion: These data suggest a decreasing trend in the incidence of lymph node metastasis in the PSA era. Although longer disease‐free intervals were observed in radical prostatectomy‐treated patients, the impact of an aggressive approach to stage D1 disease awaits further studies.