© 2010 THE AUTHORS 1238 BJU INTERNATIONAL © 2 0 1 0 B J U I N T E R N A T I O N A L | 1 0 7 , 1 2 3 8 – 1 2 4 2 | doi:10.1111/j.1464-410X.2010.09657.x 2010 THE AUTHORS; JOURNAL COMPILATION 2010 BJU INTERNATIONAL Urological Oncology PROSTATECTOMY FOR LN+ PROSTATE CANCER WIEGAND ET AL. Surgical management of lymph-node-positive prostate cancer: improves symptomatic control Lucas R. Wiegand, Mike Hernandez*, Louis L. Pisters † and Philippe E. Spiess Department of Urologic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, *Department of Biostatistics, and † Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA Accepted for publication 22 April 2010 • 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%, respectively. • Logistic regression analysis used to identify predictors of local relapse indicated that patients treated with ADT (OR = 1.96; P = 0.270) had higher odds of having a local relapse whereas patients treated with RRP + ADT (OR = 0.20; P = 0.032) had significantly lower odds of having a local relapse compared with patients treated 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). • Logistic regression analysis used to identify predictors of symptomatic local relapse, among patients having had a relapse, indicated that patients treated with RRP + ADT (OR = 2.90; P = 0.322) had higher odds of having a symptomatic local relapse whereas patients 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). CONCLUSIONS • Radical prostatectomy (with adjuvant hormonal therapy) provides improved local control in patients with lymph-node- positive prostate cancer. • This important endpoint must be considered when determining the optimal treatment of patients with node-positive disease. KEYWORDS prostate cancer, lymph-node-positive, radical prostatectomy, local control What’s known on the subject? and What does the study add? There is a paucity of data regarding symptomatic local progression of patients treated with radical prostatectomy in the setting of lymph-node-positive prostate cancer. Our retrospective study shows that radical prostatectomy with adjuvant hormonal therapy improves local control of patients in this cohort. Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE • To assess the impact of primary surgical therapy on local control for patients with lymph-node-positive prostate cancer. METHODS • A retrospective analysis from January 1982 to January 2001 identified 192 patients treated by radical retropubic prostatectomy (RRP, N = 87), hormonal ablative therapy (ADT, N = 74), or RRP plus adjuvant hormones (RRP + ADT, N = 31). • Statistical analyses were 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. RESULTS • The incidence of local relapse in the three treatment groups (RRP, ADT and RRP + ADT) was 40.2%, 59.5% and 12.9%, respectively. INTRODUCTION Lymph-node-positive prostate cancer has traditionally been treated with systemic therapy without curative intent. However, recent studies have shown that lymph-node- positive prostate cancer treated with radical retropubic prostatectomy (RRP) with or without adjuvant androgen-deprivation therapy (ADT) can have long-term cancer- specific survival [1–4]. In one of the few randomized trials regarding lymph-node- positive prostate cancer, Messing et al. [1] showed that overall, cancer-specific and progression-free survival are improved with early ADT in patients with lymph-node- positive prostate cancer. Besides this, there are few data regarding local control and progression in the setting of RRP. Of patients with prostate cancer palliated with hormones alone (i.e. without curative intent), approximately 40% will need lower urinary tract procedures and 10% will need upper urinary tract procedures before succumbing to their disease [5]. Of those without metastatic disease, 60% will require lower and 20% upper urinary tract procedures with a mean survival of 94 months [5]. The aim of the present study was to assess the impact of surgical management in this patient cohort in terms of symptomatic control and progression-free survival. MATERIALS AND METHODS Before conducting this study, a retrospective chart-review protocol was designed and approved by our Institutional Review Board. BJUI BJU INTERNATIONAL