Anatomic extent of pelvic lymph node dissection: impact on long-term cancer-specific outcomes in men with positive lymph nodes at time of radical prostatectomy.

OBJECTIVE To evaluate the impact of an extended pelvic lymph node (LN) dissection (EPLND) on the oncologic outcomes of men with LN-positive prostate cancer. METHODS Patients were identified who underwent an open radical prostatectomy by one of two surgeons at the Johns Hopkins Hospital between 1992 and 2003. The first surgeon routinely performed a limited pelvic LN dissection (LPLND), whereas the second performed an EPLND. Men with positive LNs from each cohort were compared for differences in oncologic outcomes. RESULTS Positive LNs were found in 94 men (2.2%), 21 (22.3%) with an LPLND and 73 (77.7%) with an EPLND. On average, LPLND and EPLND yielded 11.4 and 14.6 nodes, respectively (P = .022). The two groups were similar in terms of the number of positive LNs (1.4 vs 1.8, P = .223) and the proportion of patients with <15% positive nodes (57.1% vs 69.9%, P = .300). At a median follow-up of 10.5 years, patients who underwent an EPLND had superior oncologic outcomes compared with the LPLND group: 5-year biochemical recurrence-free survival of 30.1% vs 7.1% (P = .018), 10-year metastasis-free survival of 62.2% vs 22.2% (P = .035), and 10-year cancer-specific survival of 83.6% vs 52.6% (P = .199). This analysis demonstrated an augmented improvement in biochemical recurrence-free survival in men with <15% positive nodes. CONCLUSION In addition to affording valuable staging information, an EPLND may confer a therapeutic benefit to patients found to have positive LNs at the time of radical prostatectomy.