Temporal Trends and Predictors in Diagnosing Pathologic Node-Positive Prostate Cancer in Clinically Node-Negative Patients

The proportion of men without clinically node negative prostate cancer found to have positive lymph nodes at the time of prostatectomy is increasing over time, with grade groups 4 and 5 disease being the strongest predictors for pathologic node positivity. These findings help to identify patients who are likely to require additional treatments after prostatectomy, including radiation and hormone therapy. Introduction: Managing pathologically node positive (pN+) prostate cancer (PCa) is controversial. We describe temporal patterns and predictors of pN+ PCa in men with initially surgically managed clinically node negative (cN-) PCa. Materials and Methods: This observational retrospective analysis of nonmetastatic, cN- PCa uses the National Cancer Database. Multivariable logistic regression was used to identify covariates associated with pN+ disease. Cox proportional hazards modeling and Kaplan-Meier analysis were used to evaluate survival patients undergoing radical prostatectomy with or without pelvic lymph node dissection (PLND). Results: The rates of radical prostatectomy in men with grade group (GG) 4 and GG5 increased from 47.6% to 53.1% and from 42.5% to 49.5%, respectively. The annual rate increased from 2.02% in 2010 to 5.12% in 2017 (P <.001). The annual rates of PLND increased from 54.3% to 71.7%. The most significant predictor of pN+ PCa was ISUP GG4 (odds ratio [OR] 12.5, P <.001) and GG 5 (OR 26.2, P <.001). Rates of pN+ identification increased from 5.5% to 9.4% in men with GG4 and from 13.4% to 19.5% in men with GG5 (P <.001). In GG4 and GG5, patients undergoing PLND had superior survival to those managed without PLND (P <.01). Conclusion: Among patients with cN- PCa, the diagnosis of pN+ PCa has become more common over time. GG4 and GG5 are the strongest independent predictors of pN+ disease. Because incidental pN + results in upstaging these data are useful for informing discussions before radical prostatectomy. (C) 2021 Elsevier Inc. All rights reserved.