Treatment modalities vary for men diagnosed with pathologic lymph node-positive (pN1) prostate cancer. Understanding current treatment patterns and their outcomes can help provide you with insight and direction in your decision-making.
Zareba et al. described contemporary treatment methods most used in today’s clinical practice. He utilized the National Cancer Data Base (NCDB) to identify 7,791 men who were found to have lymph node metastases at the time they had a radical prostatectomy (RP).
Their analysis of the database showed that sixty-three percent (63%) of men were initially managed with just observation. Twenty percent (20%) were managed with hormone therapy (ADT) alone, five percent (5%) with radiation therapy (RT) alone and thirteen percent (13%) with ADT and RT.
They found that there is a direct association with younger age, lower co-morbidity burden (the presence of additional diseases), higher grade and stage and the presence of positive surgical margins and a higher likelihood of receiving combination therapy.
When they looked at survival data, they found that Gleason grade group 4-5 disease, pT3b-T4 disease (the tumor has invaded the seminal vesicles, bladder or rectum), positive surgical margins and a higher number of positive lymph nodes were independent predictors of worse overall survival (OS). The presence of an increasing number of adverse prognostic factors made the adjusted ten-year OS probabilities to decrease from eighty-four percent (84%) to thirty-two percent (32%).
They concluded that OS is associated with patient and tumor characteristics as well as with both the choice of post-RP management strategy and survival in men with pN1 (the tumor has spread to the regional lymph nodes) prostate cancer. They also concluded that multi-modal, or combined therapy, might benefit men with pN1 prostate cancer.
Piotr Zareba, MD MPH, James Eastham, MD, Peter T. Scardino, MD, Karim Touijer, MD MPH:DOI: http://dx.doi.org/10.1016/j.juro.2017.06.062
Joel T. Nowak, MA, MSW wrote this Post. Joel is the CEO/Executive Director of Cancer ABCs. He is a Cancer Thriver diagnosed with 5 primary cancers - Thyroid, Metastatic Prostate, Renal, Melanoma and a rare cancer, Appendiceal Cancer.