Although the indication of radical prostatectomy for lymph node-positive prostate cancer is controversy in past decades. the incidence of lymph node-positive prostate cancer is still common in high-risk disease and the challenge remains on how well to treat these patients. Here we evaluated the survival outcome of personal cohort patients with lymph node-positive prostate cancer following radical prostatectomy and standard or extend pelvic node dissection.

From1990 to 2022, Clinical records of 62 patients with lymph nodes metastases following radical prostatectomy with pelvic node dissection by one surgeon (CR Yang). Preoperative, very patients had clinical stage by DRE, biopsy Gleason score, PSA for risk assessment, Bone scan and CT scan of abdomen for r/o gross distant metastasis. In 42 patients (GPI) received standard or extend PLND with a mean node count:19 (6-46), and another 20 patients (GPII), positive node was suspected on CT and also found during surgery then received extend or supra-extend PLND and proceed radical prostatectomy with a mean count:27 (14 -64).Following surgery, Patients were followed PSA without adjuvant therapy until PSA failure (PSA>0.2ng/ml). Disease progression was treated with RT and ADT for three years or life-long. Overall survival and disease–specific survival rate calculated by using Kaplan Meier’s life-table.

There was no difference of patients age, serum PSA (35 vs 45), Gleason score, and risk level between two GPs, the mean positive node was 1.9(1 to 4) in GPI vs 5.1 (2 to 22) in GPII. The one, three years progression-free were 55, 33 % in GPI vs 18% and 5% in GPII (p=0.002), The overall 5 and10 years survival rate were 92, 82 % in GPI and only 73 and 26 for GPII. The 5 and10 years disease-specific survival rate were 95% and 83 % for GPI, and 73, 26% respectively. for GPII (P<0.001). Number of positive nodes found corelated to clinical outcome.

PLND plus radical prostatectomy may offer durable period of disease free for majority advanced or high-risk patients with limited pelvic node metastases. Long term disease control may achieve following salvage ADT and RT. The relative inferior survival for patients with clinical positive nodes indicated more advanced disease with hiding bone metastases or aggressive biological behavior.More sensitive image (PSMA pet) and earlier intervention of molecular or genetic study are warranted.