4th NEEM in Riga: Key messages on prostate cancer treatment issues

Pelvic lymph node dissection and managing pT3 prostate disease were among the topics discussed during the session on prostate cancer treatment held at the 4th North Eastern European Meeting (NEEM) which opened today in Riga, Latvia.

Goran Ahlgren (Sweden) lectured on lymph node dissection in prostate cancer during the opening session, while Dr. Ejils Vjaters examined managing pT3 prostate disease.

In his lecture, Ahlgren recommended that in cases when the surgeon opts for pelvic lymph node dissection an extended lymphadenectomy would be beneficial.

“Why do need to have lymph node dissection (LND) in prostate cancer? We want to have information about cancer stage and prognosis and potential benefit in cancer cure,” Ahlgren said, adding, however, that limited LND doesn’t provide correct lymph node staging.

Among the key messages Ahlgren‘s lecture were:

• If a PLND is performed for prostate cancer, extended PLND is recommended* PLND maybe excluded in Gleason score < 6 or 3+4 and PSA <10ng/ml
• Positive node is prognostic for disease-specific survival
• PLND may increase cure rate, if < 2-3 positive nodes.
• If node is positive, still consider to treat the prostate*Treating the prostate may be more important for survival than the LND?

Regarding pT3 prostate disease, Dr. Ejils Vjaters gave the following key messages:

For patients classified as pT3 pN0 with a high risk of local failure after RP due to positive margins (highest impact), capsule rupture, and/or invasion of the seminal vesicles, who present with a PSA level of < 0.1 ng/ml, two options can be offered: -either an immediate radiotherapy to the surgical bed upon recovery of urinary function-or clinical and biological monitoring followed by salvage radiotherapy when the PSA exceeds 0.5 ng ml,

• Neoadjuvant hormonal therapy before RP does not provide a significant disease-free survival and OS advantage over prostatectomy alone;
• Adjuvant hormonal therapy following RP shows no survival advantage at 10 years;
• Adjuvant hormonal therapy following RP: the overall effect estimate for disease-free survival was highly statistically significant in favour of the hormonal therapy arm.