The James Buchanan Brady Urological Institute
 
 
 
                 A PUBLICATION OF THE PATRICK C . WALSH PROSTATE CANCER RESEARCH FUND
   Double Good News for Men with Cancer- Positive Lymph Nodes
                 Volume 9, Winter 2013

prostate cancer
Trinity Bivalacqua and Philip Pierorazio: Men with positive
lymph nodes found in surgery can live for many years without
metastases. The men in this study were treated primarily with
surgery alone.

Although this is a story about prostate cancer that has spread to the lymph nodes, there is double good news that we are happy to report here. The findings come from a recent study of 30 years’ worth of surgeon Patrick Walsh’s radical prostatectomy patients who turned out to have clinically localized cancer with positive lymph nodes.

The study, conducted by Prostate Cancer Team Scholar Trinity Bivalacqua, M.D., Ph.D., and urology resident Philip Pierorazio, M.D., looked at men diagnosed in the “pre-PSA ” era, before 1992, as well as men whose cancer was found through PSA screening.

The first bit of good news is that the number of men diagnosed with prostate cancer in their lymph nodes has dropped from as many as 14 percent during the pre- PSA era, to about 4 percent in the early years of PSA screening, to a current low of about 1 to 2 percent. “Regular PSA screening has not only decreased the number of men being diagnosed with node-positive prostate cancer, but has undoubtedly contributed to favorable long-term survival in the men in our study,” says Bivalacqua.

The number of men diagnosed with prostate
cancer in their lymph nodes has dropped from as many
as 14 percent during the pre-PSA era
to a current low of about 1 to 2 percent.

The next good news is how well the men in this study did. They were treated primarily with surgery alone. Hormonal therapy was delayed until there was clinical evidence of progression, which in most cases was manifested by a positive bone scan. At 15 years after surgery, 7.1 percent of men had an undetectable PSA ; 35.1 percent had a detectable PSA but no evidence of metastases; and 57.5 percent were alive and had not died of prostate cancer. The strongest predictors of a favorable outcome were the Gleason score on the radical prostatectomy specimen and the percent (not number) of positive lymph nodes (men with 15 percent or fewer positive lymph nodes did better). In summary, this study shows that highly selected men with positive lymph nodes at the time of radical prostatectomy can live for many years without metastases or other evidence of cancer.


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