Features and management of men with pN1 cM0 prostate cancer after radical prostatectomy and lymphadenectomy: a systematic review of population-based evidence

Laine, Charles; Gandaglia, Giorgio; Valerio, Massimo; Heidegger, Isabel; Tsaur, Igor; Olivier, Jonathan; Ceci, Francesco; Bergh, Roderick C. N. van den; Kretschmer, Alexander; Thibault, Constance; Chiu, Peter K.; Tilki, Derya; Kasivisvanathan, Veeru; Preisser, Felix; Zattoni, Fabio; Fankhauser, Christian; Kesch, Claudia; Puche-Sanz, Ignacio; Moschini, Marco; Pradere, Benjamin; Ploussard, Guillaume und Marra, Giancarlo (2022): Features and management of men with pN1 cM0 prostate cancer after radical prostatectomy and lymphadenectomy: a systematic review of population-based evidence. In: Current Opinion in Urology, Bd. 32, Nr. 1: S. 69-84

Abstract

Purpose of review To investigate the features and optimal management of pN+ cM0 prostate cancer (PCa) according to registry-based studies. Recent findings Up to 15% of PCa patients harbor lymph node invasion (pN+) at radical prostatectomy plus lymph node dissection. Nonetheless, the optimal management strategy in this setting is not well characterized. We performed a systematic review including n = 13 studies. Management strategies comprised 13 536 men undergoing observation, 11 149 adjuvant androgen deprivation therapy (aADT), 7,075 adjuvant radiotherapy (aRT) +aADT and 705 aRT. Baseline features showed aggressive PCa in the majority of men. At a median follow-up ranging 48-134months, Cancer-related death was 5% and overall-mortality 16.6%. aADT and aRT alone had no cancer-specific survival or overall survival advantages over observation only and over not performing aRT, respectively. aADT plus aRT yielded a survival benefit compared to observation and aADT, which in one study, were limited to certain intermediate-risk categories. Age, Gleason, Charlson score, positive surgical margins, pathological stage, and positive nodes number, but not prostate specific antigen, were most relevant prognostic factors. Our work further confirmed pN+ PCa is a multifaceted disease and will help future research in defining its optimal management based on different risk categories to maximize survival and patient's quality of life.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0963-0643
• Sprache: Englisch