The role of radical surgery in the treatment of lymph node positive prostate cancer

Abstract

There is no clear consensus on how to manage a subset of patients with prostate cancer (PCa) who present with involved lymph nodes (LN+). Although outcomes for these patients are uniformly worse than those for patients with localized PCa, they are better than outcomes for patients with bone metastases, with more than 60% of patients alive at 10 years after the initial diagnosis. Although radical prostatectomies in patients with clinical lymphadenopathy were abandoned in the era before widespread adoption of PSA screening, radical prostatectomy with extended pelvic lymphadenectomy can help achieve durable cancer control in the contemporary practise. The use of multimodal treatment, including surgery, adjuvant radiotherapy, and ADT, is particularly relevant for younger patients who are at high risk for local and distant relapse over the course of their lives and who may need all treatments to achieve optimal outcomes. Although there is a lack of data from prospective randomized trials directly comparing radiotherapy and radical prostatectomy, retrospective studies and registries suggest that surgery may offer benefits in terms of biochemical recurrence-free survival, metastasis-free survival, prostate-cancer-specific mortality, and overall survival.