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Extent of Lymph Node Dissection in Prostatectomy: An Update From ASCO 2017

Interview with Thomas J Guzzo MD, MPH

‘Filmed by PracticeUpdate with permission for inclusion on Uro Onco. More information and additional ASCO coverage can be found at www.practiceupdate.com

Interview transcript

Dr. Farzanna Haffizulla:

Thank you for joining us for this PracticeUpdate. I’m Dr. Farzanna Haffizulla. Joining me today is Dr. Thomas Guzzo. Dr. Guzzo is an Assistant Professor of Urology and Surgery at the University of Pennsylvania’s Perelman Center for Advanced Medicine. Great to have you back Dr. Guzzo.

Dr. Thomas Guzzo:

Thank you for having me.

Dr. Farzanna Haffizulla:

Absolutely. I wanted to talk about the group from Sao Paulo conducting the phase 3 trial comparing limited and extended lymphadenectomy in prostate cancer. Can you tell us how the results of this particular study can affect clinical practice?

Dr. Thomas Guzzo:

Sure. So there is a lot of question as to what the extent of lymph node dissection should be in a variety of cancers. In urology, we debate all the time what the extent of a lymph node dissection should be in both bladder cancer and prostate cancer and there’s a lot of retrospective data that says the more lymph nodes that you take out the potentially better the patient’s going to do not only from knowing their stage standpoint but potentially from an oncologic standpoint as well. This group actually did a prospective study, a phase 3 randomized trial including patients with intermediate and high-risk prostate cancer, and they randomized them to a standard limited pelvic lymph node dissection that you would expect that most prostate cancer patients would get versus an extended pelvic lymph node dissection. And what they found was that the groups were very well matched, as you would expect in a randomized trial, and the patients were no different pathologically. So what they found was there was no difference in the groups preoperatively with regard to clinical or pathologic features but what they found, as you would expect, they found 6 times the amount of metastatic disease in the extended pelvic lymph node patients because obviously, they were taking more lymph nodes out, but importantly, the oncologic outcomes weren’t the same.

Now, this is very early data and you would expect potentially with further follow-up that may change, but the oncologic outcomes were the same. I still think this is an important study because in prostate cancer we have many new therapies for patients with advanced disease and I think knowing which patients have metastatic disease early on may direct adjuvant and salvage therapies after radical prostatectomies, so still a very important study.

Dr. Farzanna Haffizulla:

Without a doubt, I completely agree. What is your current clinical practice in determining who should get a limited versus an extended lymphadenectomy?

Dr. Thomas Guzzo:

Sure. So I use nomograms like most physicians do and patients with intermediate to high-risk disease, particularly high-risk disease, I will do an extended pelvic lymph node dissection for prostate cancer, and again, I think it gives us very important staging information. The jury’s still out as to whether it changes oncologic outcomes, but I do think patients want to know where they stand from a disease standpoint, and I do think it can help us make decisions postoperatively with regard to adjuvant therapies.

Dr. Farzanna Haffizulla:

Excellent. Well we want to thank you very much for sharing your expertise today on PracticeUpdate and looking forward to hearing more from you.

Dr. Thomas Guzzo:

Thank you.

Dr. Farzanna Haffizulla:

To our viewers, thank you for joining us for this PracticeUpdate. I’m Dr. Farzanna Haffizulla. Please join us soon.

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