A critical assessment of the value of lymph node dissection at radical prostatectomy: A population-based study

OBJECTIVE. We tested relationship between pelvic lymph node dissection (PLND) status at the time of radical prostatectomy (RP) and survival in prostate cancer (PCa) patients. METHODS. Overall, 127,824 PCa patients treated with RP between 1988 and 2006 were included. Univariable and multivariable Cox regression analyses were used to evaluate the impact of PLND status (pN0 vs. pNx vs. pN1) on cancer-specific mortality (CSM) and overall mortality (OM) rates. RESULTS. In pT2 patients, the 5-, 10-, and 15-year CSM rates were: 0.4%, 1.7%, and 3.9% for pN0, 0.6%, 2.5%, and 4.7% for pNx, 2.7%, 11.9%, and 20.6% for pN1 patients (all P < 0.001). The 5-, 10-, and 15-year OM rates were: 5.4%, 16.3%, and 34.5% for pN0, 6.1%, 18.2%, and 35.3% for pNx, 11.5%, 32.7%, and 53.4% for pN1 (all P < 0.001). In multivariable analyses, pNx and pN1 stage increased CSM rate, respectively by 1.3- and 3.8-fold (both P < 0.001) relative to pN0. Similarly, pNx and pN1 increased OM rate respectively by 1.1- and 1.6-fold (both P < 0.001) relative to pN0. In pT3 patients, pNx stage did not significantly increase CSM or OM rates relative to pN0 (both P > 0.05). CONCLUSIONS. Patients with localized PCa treated with RP without a PLND (pNx) have less favorable survival rate than their counterparts that do not harbor lymph node invasion at PLND. However, the difference is modest (0.8% at 10 years). In consequence, the related costs and benefits of this procedure should be weighted carefully. In addition, the survival benefit of PLND was not observed in locally advanced PCa patients. Prostate 71: 1587-1594, 2011. (C) 2011 Wiley-Liss, Inc.