Radical prostatectomy – is accompanying hormonal treatment necessary when cancer is found in lymph nodes?

The authors aimed to determine outcomes in patients with whose prostate cancer has spread to the lymph nodes and were treated with prostate surgery but without accompanying hormone treatment. 

In some patients prostate cancer tumors can spread to other parts of the body, including the lymph nodes which hold the cells that fight infection. In patients with lymph node tumors typical treatment involves radical prostatectomy (surgically removing the prostate from the patient). This is often accompanied by androgen deprivation therapy (ADT). ADT is a form of hormone treatment that targets male sex hormones, such as testosterone, involved in prostate cancer. However, while some studies show a benefit associated with ADT, others show that those with low levels of cancer spread may not need immediate hormonal therapy. 

The aim of this study was to determine patient outcome when treated with radical prostatectomy but without ADT for lymph node tumors.

369 patients were evaluated in this study who received a radical prostatectomy, with a follow-up time of 4 years. The predicted 5-year overall survival (percentage of patients who survived at 5 years) was 91% while the predicted 10-year survival was 60%. Predicted 5-year cancer-specific survival (patients who did not die from cancer following treatment) was 94% while predicted 10-year cancer-specific survival was 72%.

The 5-year probability of freedom from tumor spread was 79%, while 10-year freedom probability rates were 65%. Patients with high Gleason scores (grading system that compares the differences between normal and cancer cells) or patients with 3 or more affected lymph nodes were nearly 3 times more likely to experience tumor spread after radical prostatectomy. Patients with positive surgical margins (tissue removed during prostate surgery that shows cancer cells are still present) also had an increased risk of tumors spreading.

54% of patients experienced biochemical recurrence (increase in PSA levels indicating prostate cancer growth despite treatment).The 5-year probability of freedom from recurrence was 35% while the 10-year probability was 28%. High Gleason scores and PSA levels more than doubled the risk of experiencing cancer recurrence. Patients who had more than 3 infected lymph nodes removed also had a significantly increased risk of experiencing biochemical recurrence.

The authors concluded that some patients with lymph node tumors remained disease-free 10 years after receiving radical prostatectomy without ADT,  and that patients with low Gleason scores and lymph node tumors were favorable candidates for this form of treatment.

This study was retrospective in nature, meaning it surmised results from patient records. 

If you are considering radical prostatectomy and would like more information on whether accompanying ADT is warranted, please discuss with your physician.