67 Background: Salvage prostatectomy (SP) in radiation resistant prostate cancer is feasible in select patients that do not have metastatic disease. The correlation between the extent of pelvic lymph node dissection (PLND) and long-term survival in SP has not been clearly established. This study evaluates the role of PLND on long-term survival outcome in men that underwent radical prostatectomy (RP) following radiation. Methods: SEER 18 registry was searched for patients that underwent RP following radiation for adenocarcinoma of the prostate between 1988 and 2010. The patients were analyzed for demographics, grade and stage, pelvic lymph node status, nodal yield and survival. Patients with metastatic disease, more than one primary cancer and unknown stage were excluded. Results: 364 men were identified. Mean age was 63.6 years and 86.3% were white. Grade differentiation was well (n=12), moderate (n=198), poor (n=150) and unknown (n=4). The T stage was pT2 (n=178), pT3 (n=90) and pT4 (n=96). PLND was performed in 78.6% (n=286) of the patients. The nodal yield was 0-5 (n=75), 6-10 (n=45) and >10 (78). For the 40 patients with positive nodes (PN), 25 (62.5%) had 1 PN, 8 (20%) had 2 PN and 7 (17.5%) had >2 PN. The 10 and 20-year overall survival (OS) was 77.5% and 37.3% and cancer specific survival (CSS) was 88.6% and 72.7%, respectively. The CSS at 20 years was >70% for all grades and stages. On comparison, there was no significant improvement in survival for PLND vs. no PLND (p=0.14) but there was a trend toward improved CSS for patients undergoing PLND. There was no significant improvement (p=0.89) in survival for increasing total nodal yield. CSS at 20 years for N0 and N1 patients was 75% and 65%, respectively. Patients with 0 or 1 PN had similar 20 year CSS of ~75%. Patients with 2 PN had the worst survival with CSS of 30% at 15 years. Conclusions: Good long-term survival can be achieved with RP following radiation therapy. Patients who have node positive disease have similar long-term outcomes to patients that are node negative. However, patients with 2 PN have the worst survival. PLND status and extent of nodal dissection does not significantly confer a survival advantage.
Metastatic Mucinous Adenocarcinoma of the Prostate with PSA Value of 8.6 ng/mL at 5-Year-Followup after Prostatectomy, Radiotherapy, and Androgen Deprivation
