title: The impact of definitive local therapy for lymph node-positive prostate cancer: a population-based study.
abstract: OBJECTIVE
  To evaluate the survival outcomes for patients with lymph node-positive, nonmetastatic prostate cancer undergoing definitive local therapy (radical prostatectomy [RP], external beam radiation therapy [EBRT], or both) versus no local therapy (NLT) in the US population in the modern prostate specific antigen (PSA) era.
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results database was queried for patients with T1-4N1M0 prostate cancer diagnosed from 1995 through 2005. To allow comparisons of equivalent datasets, patients were analyzed in separate clinical (cN+) and pathologically confirmed (pN+) lymph node-positive cohorts. Kaplan-Meier overall survival (OS) and prostate cancer-specific survival (PCSS) estimates were generated, with accompanying univariate log-rank and multivariate Cox proportional hazards comparisons.
  
  
  RESULTS
  A total of 796 cN+ and 2991 pN+ patients were evaluable. Among cN+ patients, 43% underwent EBRT and 57% had NLT. Outcomes for cN+ patients favored EBRT, with 10-year OS rates of 45% versus 29% (P<.001) and PCSS rates of 67% versus 53% (P<.001). Among pN+ patients, 78% underwent local therapy (RP 57%, EBRT 10%, or both 11%) and 22% had NLT. Outcomes for pN+ also favored local therapy, with 10-year OS rates of 65% versus 42% (P<.001) and PCSS rates of 78% versus 56% (P<.001). On multivariate analysis, local therapy in both the cN+ and pN+ cohorts remained independently associated with improved OS and PCSS (all P<.001). Local therapy was associated with favorable hazard ratios across subgroups, including patients aged ≥70 years and those with multiple positive lymph nodes. Among pN+ patients, no significant differences in survival were observed between RP versus EBRT and RP with or without adjuvant EBRT.
  
  
  CONCLUSIONS
  In this large, population-based cohort, definitive local therapy was associated with significantly improved survival in patients with lymph node-positive prostate cancer.
authors.affiliation: Department of Radiation Oncology, University of Colorado-Denver, Aurora, Colorado. Electronic address: chad.rusthoven@ucdenver.edu.
authors.forename: Chad G
authors.initials: CG
authors.lastname: Rusthoven
authors.affiliation: Department of Radiation Oncology, University of Colorado-Denver, Aurora, Colorado.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Carlson
authors.affiliation: Department of Radiation Oncology, University of Colorado-Denver, Aurora, Colorado.
authors.forename: Timothy V
authors.initials: TV
authors.lastname: Waxweiler
authors.affiliation: Department of Radiation Oncology, University of Colorado-Denver, Aurora, Colorado.
authors.forename: David
authors.initials: D
authors.lastname: Raben
authors.affiliation: Department of Biostatistics, University of Colorado-Denver, Aurora, Colorado.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Dewitt
authors.affiliation: Department of Radiation Oncology, University of Colorado-Denver, Aurora, Colorado; Department of Urology, University of Colorado-Denver, Aurora, Colorado.
authors.forename: E David
authors.initials: ED
authors.lastname: Crawford
authors.affiliation: Department of Urology, University of Colorado-Denver, Aurora, Colorado.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Maroni
authors.affiliation: Department of Radiation Oncology, University of Colorado-Denver, Aurora, Colorado.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Kavanagh
mesh_terms: D000368:Aged; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D011878:Radiotherapy / Q000379:methods; D012189:Retrospective Studies; D018426:SEER Program; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen