In many places it is a common practice to stop a radical prostatectomy (prostate gland removal) if the surgeon finds that the patient has positive lymph nodes. Since positive nodes are considered systemic disease as opposed to a localized disease, many physicians have felt there is no reason to complete the surgery and subject the man to the potential negative side effects of the surgery.

In a recent study, the overall and cancer specific survival in men with prostate cancer and positive pelvic nodes with terminated or completed radical prostatectomy was evaluated.

The study analyzed a total of 35.629 men with prostate cancer between 1988 and 2007 at the Munich Cancer Registry. Of these, 1413 patients had a positive lymph node status and underwent pelvic lymph node dissection (PLND) with or without radical prostatectomy for presumed localized prostate cancer. Of these, 456 had a positive pelvic lymph nodes and radical prostatectomy was abandoned, whereas 957 underwent PLND and radical retropubic prostatectomy. Kaplan-Meier curves and Cox regression analysis were used to test influence of predictors (age at surgery, prostate specific antigen level, grading and extend of surgery) and cancer specific and overall survival.

The median follow up time was 5.6 years. Overall survival of the men who had a completed radical prostatectomy at 5 and 10 years was 84% and 68%, and in men with abandoned surgery at 5 and 10 years was 60% and 28%, respectively. Prostate cancer specific survival of patients with complete surgery at 5 and 10 years was 90% and 95%, and in patients with abandoned surgery at 5 and 8 years was 70% and 40%, respectively. In the multivariate model, terminated radical prostatectomy was the strongest predictor of survival (HR 2.49 [95% CI, 1.95, 3.17, p<.0001]).Those men with positive lymph nodes and who still had a completed radical prostatectomy have a significantly improved overall and prostate cancer specific survival rate compared to men with abandoned surgery. The clear results indicate that men with lymph node positive prostate cancer should still undergo a radical prostatectomy.I believe that these results are so significant that even those men who have had abandoned surgery, should discuss with their oncologist the possibility of having the surgery.Men who are preparing to have surgery should also insist that their surgeons complete the surgery even if they find positive lymph nodes.Reference:Urology Department, Ludwig-Maximilian-University, Munich, Germany by Patrick J. Bastian, Helmut Baur, Volker Beer, Christian Chaussy, Jürgen Gschwend , Dieter Hölzel and Christian G. StiefFor presentation at the 25th Annual Meeting of the Urological Research Society (URS), August 10 - 14, 2009, Thala Beach, North Queensland, AustraliaJoel T Nowak MA, MSW