title: Natural History of Clinical Recurrence Patterns of Lymph Node-Positive Prostate Cancer After Radical Prostatectomy.
abstract: BACKGROUND
  Patients with lymph node (LN)-positive prostate cancer (PCa) at radical prostatectomy (RP) face a high risk of cancer recurrence. Nevertheless, recurrence patterns of LN-positive PCa and their prognostic significance remain understudied in the literature.
  
  
  OBJECTIVE
  To analyze a large single-institution series with long-term follow-up to elucidate the various clinical recurrence patterns of LN-positive PCa and their association with oncologic outcomes.
  
  
  METHODS
  Years 1987-2012 of a prospectively maintained institutional RP registry were queried for men with LN-positive PCa at RP. Clinical recurrences were categorized as local, nodal, skeletal, or visceral.
  
  
  METHODS
  In addition to descriptive statistics and Kaplan-Meier analysis, univariable and multivariable Cox proportional hazards models were constructed to predict recurrence and to quantify the impact of recurrence patterns on cancer-specific mortality (CSM).
  
  
  CONCLUSIONS
  Data from 1011 men with LN-positive PCa at RP were analyzed with 17.6 yr of median follow-up. The 15-yr clinical recurrence rate was 33% (95% confidence interval [CI], 31-35%) for all patients and 52.2% (95% CI, 47.3-57.1%) for patients with biochemical recurrence. The solitary locations were skeletal (n=94, 55%), nodal (n=59, 34%), local soft tissue (n=29, 17%), and visceral (n=8, 5%). Significant multivariable predictors of recurrence were Gleason score 8-10, number of positive nodes, pathologic Gleason score, and more recent year of surgery. The 15-yr CSM after clinical recurrence was 80%, with a mean overall survival of 30 mo after recurrence. On multivariable analysis, recurrences after 5 yr from RP (hazard ratio [HR]: 0.05), multiple recurrences (HR: 1.97), skeletal (HR: 3.13), and visceral metastases (HR: 7.43) were independently associated with CSM (all p<0.05).
  
  
  CONCLUSIONS
  Recurrences after RP for LN-positive PCa are heterogeneous in terms of time from RP, location, and number of concomitant lesions.
  
  
  RESULTS
  We found that impact of recurrence patterns on cancer-specific mortality varies significantly and allows these patients to be stratified for purposes of prognostication, follow-up, and therapy.
authors: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors: Marco
authors: M
authors: Moschini
authors: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors: Vidit
authors: V
authors: Sharma
authors: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors: Fabio
authors: F
authors: Zattoni
authors: Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA.
authors: J Fernando
authors: JF
authors: Quevedo
authors: Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.
authors: Brian J
authors: BJ
authors: Davis
authors: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors: Eugene
authors: E
authors: Kwon
authors: Department of Urology, Mayo Clinic, Rochester, MN, USA. Electronic address: Karnes.R@mayo.edu.
authors: R Jeffrey
authors: RJ
authors: Karnes
mesh_terms: D000368:Aged; D001859:Bone Neoplasms / Q000556:secondary*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary*; D008175:Lung Neoplasms / Q000556:secondary*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D017430:Prostate-Specific Antigen
keywords: Lymph node; Metastasis; Prostate cancer; Recurrence