Clinical outcome of patients with lymph node positive prostate cancer after radical prostatectomy versus androgen deprivation

Objective(s): To compare the outcome of patients with stage D1 (TxN+MO) prostate cancer undergoing radical prostatectomy or androgen deprivation alone. Patients and Methods: Eighty-two patients treated for lymph node positive prostate cancer were retrospectively analyzed for time to progression, tumor-specific and overall survival. Furthermore, subsequent tumor and treatment related morbidity requiring intervention including frequency and duration of associated hospital stays was recorded. Results: The extent of lymph node metastasis was significantly lower in 50 patients undergoing radical prostatectomy ( early androgen deprivation) compared to 32 receiving androgen deprivation only. The treatment groups, however, did not differ with regard to other characteristics including age, comorbidity, stage, grade and preoperative PSA. Mean actuarial progression-free, and tumor-specific survival was significantly longer for the radical prostatectomy patients (36% and 47%, respectively at 10 years) compared to androgen deprivation (15% and 32%, respectively). The latter group required more secondary interventions resulting in more frequent and overall longer hospital stays. Conclusions: Patients undergoing radical prostatectomy for stage D I prostate cancer possibly benefit with regard to the necessity for secondary interventions and, at least for limited (solitary) nodal disease, in terms of progression free and tumor-specific survival. However, the latter observation may be biased by a larger extent of lymph node metastasis in the androgen deprivation group. (C) 2002 Elsevier Science B.V. All rights reserved.