Stop or go after positive lymphadectomy?

A recent study has concluded that men undergoing surgical treatment for prostate cancer have a survival benefit if the radical prostatectomy is completed, regardless of their lymph node status.

The surgical removal of one or more lymph nodes (lymph node dissection or lymphadectomy) is standard procedure during radical prostatectomy, if surgeons suspect that there’s a good chance the cancer has spread to the lymph nodes (a sign of systemic as opposed to locally contained disease). The lymph nodes are examined by the pathologist; if they are positive (i.e. found to contain cancer), the surgeon will usually stop the operation, because the removal of the prostate gland is thought to be effective only for localized prostate cancer.

A new German study identified 35,629 men from a database, 1413 of whom were found to be lymph-node positive. Of these 1413 men, 957 went on to have the radical prostatectomy (RP group) while the other 456 did not (no-RP group). The study found that survival odds were considerably better for those lymph node-positive patients whose surgery proceeded. After five-year and 10-year follow-up, overall survival was 84% and 64%, respectively, for the RP group, compared to 60% and 28% for the no-RP group. Despite an imbalance in the number of positive nodes in the two groups (17% in the RP group versus 28% of those in the no-RP group had four or more positive nodes), RP was a strong independent predictor of survival.

The study calls into question whether abandoning surgery in patients with positive lymph nodes is always justified.