title: Long-term PSA-free survival and castration-free survival with delayed antiandrogen therapy in patients with one versus two or more positive nodes at prostatectomy.
abstract: OBJECTIVE
  To analyze time in relation to biochemical recurrence (BCR) and antiandrogen therapy (ADT) in patients with node metastasis at retropubic prostatectomy (RRP) and to identify prognostic factors of BCR- and ADT-free survival.
  
  
  METHODS
  Positive node patients at RRP and extended pelvic lymph node dissection (ePLND) were recruited retrospectively. Neoadjuvant and adjuvant therapy were exclusion criteria. BR was defined as PSA ≥ 0.3 ng/ml or the beginning of salvage radiotherapy or, ADT.
  
  
  RESULTS
  Between 1995 and 2008, 70 node-positive patients after RRP were followed without ADT. Overall, BCR-free survival was 77.9% at 2 years and 29.7% at 8 years. The median time to BCR was 59.2 months for patients with only one node compared to 27.7 months for those with ≥2 nodes. The number of positive nodes was the only independent predictor of BCR in Cox regression multivariable analysis. ADT-free survival was 78% at 2 years and 39% at 8 years. The median time to ADT for patients with only one positive node was 115 months, and the 5 years ADT-free survival was 68.8%. Gleason score and the number of positive nodes were the only independent prognostic factors of time to ADT in the Cox regression multivariable analysis.
  
  
  CONCLUSIONS
  The prognosis of patients with positive nodes after RRP and ePNLD is good in terms of BCR- and ADT-free survival. After 8 years, 29.7% were still free from BCR, and 39% did not receive ADT. The number of positive nodes was the most important predictor of BCR- and ADT-free survival.
authors.affiliation: Department of Urology l'Hotel Dieu de Quebec, Centre de Recherche-CHUQ, Université Laval Québec, 11, Cote du Palais, Québec, QC, G1R2J6, Canada. mlodde@hotmail.com
authors.forename: Michele
authors.initials: M
authors.lastname: Lodde
authors.forename: Louis
authors.initials: L
authors.lastname: Lacombe
authors.forename: Angelo
authors.initials: A
authors.lastname: Naselli
authors.forename: Paolo
authors.initials: P
authors.lastname: Puppo
authors.forename: Michael
authors.initials: M
authors.lastname: Mian
authors.forename: Yves
authors.initials: Y
authors.lastname: Fradet
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D018572:Disease-Free Survival; D006801:Humans; D007610:Kallikreins / Q000097:blood*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010388:Pelvis; D011379:Prognosis; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen