Diagnosed with lymph-node positive prostate cancer, what are the best treatment options?  Should you add surgery to hormone therapy? These are important questions which have not yet been adequately answered.

To help to begin to answer this question, researchers at Department of Urologic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL. and the Department of Bio-statistics Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, TX. performed a retrospective analysis of 192 men.

The subject men had been treated by radical prostatectomy (RRP, N= 87), hormonal ablative therapy (ADT, N= 74), or RRP plus adjuvant hormones (RRP + ADT, N= 31). The  researchers evaluated the records of these men spanning the time period of January 1982 to January 2001. Statistical analysis was conducted using the Kruskal-Wallis test, chi-squared or Fisher’s exact test, log-rank test and logistic regression with the statistical significance level set at P < 0.05.

1)- The incidence of local relapse in the three treatment groups (RRP, ADT and RRP + ADT) was 40.2%, 59.5% and 12.9%.

2)- Among those with local relapse, the incidence of symptomatic local relapse (defined as local symptoms secondary to locally recurrent prostate cancer) was 25.7%, 75.0% and 50.0%.

3)- Logistic regression analysis used to identify predictors of local relapse indicated that the men treated with ADT (OR = 1.96; P= 0.270) had higher odds of having a local relapse.  Where men treated with RRP + ADT (OR = 0.20; P= 0.032) had significantly lower odds of having a local relapse compared with men treated solely with RRP (reference group) after adjusting for other significant predictors such as increases in serum PSA at diagnosis (OR = 1.09; P= 0.018) and biochemical failure after primary therapy (OR = 48.3; P < 0.001).

4)- Logistic regression analysis used to identify predictors of symptomatic local relapse, among patients having had a relapse, indicated that the men treated with RRP + ADT (OR = 2.90; P= 0.322) had higher odds of having a symptomatic local relapse whereas men treated with ADT alone (OR = 8.67; P < 0.001) had significantly higher odds of having a symptomatic local relapse compared with patients treated with RRP (reference group).

The Bottom-Line was that radical prostatectomy with adjuvant hormonal therapy provides improved local control in patients with lymph-node-positive prostate cancer.

Reference: BJU Int. 2010 Sep 29. Epub ahead of print.
doi: 10.1111/j.1464-410X.2010.09657.x, Wiegand LR, Hernandez M, Pisters LL, Spiess PE

PubMed Abstract
PMID: 20880197

Joel T Nowak, M.A., M.S.W.