P4 Evaluation of surgical lymph node dissection versus pelvic lymph node irradiation in high-risk prostate cancer treated with external radiation therapy
Year: 2025
Type: article
Abstract: Introduction & Objectives: High-risk prostate cancer (PCa) is an aggressive malignancy with a high risk of progression, metastasis, and poor survival outcomes. The role of pelvic lymph node dissection (PLND) in its management remains unclear. While extended prostate and pelvic lymph node irradiation is commonly used with external beam radiation therapy (EBRT), limited research has evaluated the effectiveness of PLND in this setting. This study compares PLND combined with prostate RT versus extended RT in high-risk PCa patients to assess their impact on disease control. Materials & Methods: This prospective, single-center study included 68 high-risk PCa patients (PSA >20 ng/mL and/or ≥cT2c and/or Gleason score ≥8) who underwent either PLND with prostate RT or extended RT. The PLND+RT group received 80 Gy to the prostate and seminal vesicles, while the extended RT group received an additional 50 Gy to the pelvic lymph nodes. All patients received androgen deprivation therapy (ADT) for three years. The primary outcomes were biochemical recurrence-free (BCR-free) survival and metastasis-free (MTS-free) survival, assessed from treatment initiation. Statistical analyses compared the impact of treatment modality (PLND+RT vs. extended RT) on these outcomes. Results: The median age was 71.5 years (IQR: 67-75.5), and the median PSA was 15.7 ng/mL (IQR: 8-27.7). Both groups were homogeneous in age, clinical stage, biopsy Gleason score, clinical lymph node status and pre-treatment PSA. PNLD+RT was performed in 26 patients (38%), while 42 (62%) received extended RT. The median follow-up was 45.7 months (IQR: 30-58.8). BCR occurred in 23.1% of PLND patients and 11.9% in the extended RT group (p = 0.19). MTS was detected in 23.1% vs. 7.1% of cases, respectively (p = 0.07). Estimated 3 and 5-years BCR-free survival in the entire group was 92 % and 67.9 %, and MTS-free survival was 95.2 % and 58.5 %. 3 and 5- years BCR-free survival was worse in PNLD+RT group than in the extended RT group: 90.1 % vs. 87.1% and 56.7 % vs. 74.1 %, respectively (p = 0.03). 3 and 5-years MTS-free survival was better in the extended RT group: 92.9 % vs. 96.4 % and 57.1 % vs. 82.7 %, respectively (p = 0.048). Conclusions: In high-risk PCa patients treated with external RT, PLND did not provide significant benefits in preventing early disease progression. Extended RT was associated with improved BCR-free and MTS-free survival, but the differences were modest. A longer followup is required to determine the long-term oncological impact of each approach.
Source: European Urology Open Science
Authors: K. Snarskis, D. Milonas, A. Maciulis
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,800
OpenAlex ID: W4411327257