This study examined prostate surgery as a treatment option for prostate cancer with lymph node involvement. Researchers reported that prostate surgery alone is associated with good treatment outcomes in men with low levels of prostate cancer spread.

In some patients, prostate cancer cells can spread to local lymph nodes (sites that hold immune cells). Such cases are associated with an increased risk of cancer recurrence. Therefore, aggressive treatment is often recommended. This typically involves radiation therapy or prostate surgery combined with androgen deprivation therapy (ADT). ADT is a type of hormone therapy that targets the production of male hormones (such as testosterone) and reduces their effect on cancer cell growth.

Recent studies are suggesting that low levels of cancer spread may not require additional ADT. Since ADT is associated with many side effects, predicting treatment success of prostate surgery alone may reduce the need for additional ADT.

The aim of this study was to analyze treatment outcomes of prostate surgery without additional ADT.

This study examined the records of 87 men with prostate cancer that spread to local lymph nodes. 40.2% of men had 1 lymph node testing positive for cancer cells. 24.1% of men had 2 positive lymph nodes. 36.8% of men had 3 or more positive lymph nodes. All men underwent prostate surgery with lymph node removal. The average number of lymph nodes removed during surgery was 21. None of the men received additional ADT after prostate surgery. Treatment outcomes were followed for an average of 5 years.

5-year overall survival rate (proportion who have not died from any cause since treatment) was 86.1%. Cancer-specific survival (proportion who have not died from prostate cancer since treatment) was 89.6%.

19% of men did not experience cancer recurrence after prostate surgery. Men with 2 or more positive lymph nodes were 2.2-times more likely to experience cancer recurrence. The likelihood of recurrence was increased 2.4-fold among men with more aggressive cancer cells (Gleason score of 8 or higher). 90% of men who showed no cancer recurrence had only a single positive lymph node and 50% had a Gleason score of 7.

Overall, 71% of men were free of metastasis (cancer spread) 5 years after treatment. The presence of 2 or more positive lymph nodes was found to significantly increase the likelihood of metastasis. 

Researchers concluded that prostate surgery without additional ADT is a suitable treatment option for men with low levels of prostate cancer spread. Men with a single positive lymph node and a Gleason score of 7 are at low risk of cancer recurrence after prostate surgery. 

Larger trials are needed to confirm these preliminary findings.