title: Removal of limited nodal disease in patients undergoing radical prostatectomy: long-term results confirm a chance for cure.
abstract: OBJECTIVE
  In 2003 we reported on the outcomes of 88 patients with node positive disease who underwent radical prostatectomy and pelvic lymph node dissection (median 21 nodes) between 1989 and 1999. Patients with limited nodal disease appeared to have a good chance of long-term survival, even without immediate adjuvant therapy (androgen deprivation therapy and/or radiotherapy). In this study we update the followup in these patients and verify the reported projected probability of survival.
  
  
  METHODS
  The projected 10-year cancer specific survival probability after the initially reported followup of 3.2 years was 60% for these patients with node positive disease. The outcome has been updated after a median followup of 15.6 years.
  
  
  RESULTS
  Of the 39 patients with 1 positive node 7 (18%) remained biochemically relapse-free, 11 (28%) showed biochemical relapse only and 21 (54%) experienced clinical progression. Of these 39 patients 22 (57%) never required deferred androgen deprivation therapy and 12 (31%) died of prostate cancer. All patients with 2 (20) or more than 2 (29) positive nodes experienced biochemical relapse and only 5 (10%) of these 49 experienced no clinical progression. Of these 49 patients 39 (80%) received deferred androgen deprivation therapy.
  
  
  CONCLUSIONS
  Biochemical relapse is likely in patients with limited nodal disease after radical prostatectomy and pelvic lymph node dissection, but for 46% of patients this does not imply death from prostate cancer. Patients with 1 positive node have a good (75%) 10-year cancer specific survival probability and a 20% chance of remaining biochemical relapse-free even without immediate adjuvant therapy.
authors.affiliation: Department of Urology, University of Bern, Bern, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: Seiler
authors.affiliation: Department of Urology, University of Bern, Bern, Switzerland.
authors.forename: Urs E
authors.initials: UE
authors.lastname: Studer
authors.affiliation: Department of Urology, University of Bern, Bern, Switzerland.
authors.forename: Konrad
authors.initials: K
authors.lastname: Tschan
authors.affiliation: Department of Urology, University of Bern, Bern, Switzerland.
authors.forename: Pia
authors.initials: P
authors.lastname: Bader
authors.affiliation: Department of Urology, University of Bern, Bern, Switzerland. Electronic address: fiona.burkhard@insel.ch.
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Burkhard
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome
keywords: lymphatic metastasis; prostatectomy; prostatic neoplasms; treatment outcome