Prostate Cancer

Natural History of Clinical Recurrence Patterns of Lymph Node–Positive Prostate Cancer After Radical Prostatectomy

By: Marco Moschini , Vidit Sharma , Fabio Zattoni , J. Fernando Quevedo , Brian J. Davis , Eugene Kwon and R. Jeffrey Karnes

European Urology, Volume 69 Issue 1, January 2016, Pages 135-142

Published online: 01 January 2016

Keywords: Prostate cancer, Lymph node, Recurrence, Metastasis

Abstract Full Text Full Text PDF (1,2 MB) Patient Summary



Patients with lymph node (LN)-positive prostate cancer (PCa) at radical prostatectomy (RP) face a high risk of cancer recurrence. Nevertheless, recurrence patterns of LN-positive PCa and their prognostic significance remain understudied in the literature.


To analyze a large single-institution series with long-term follow-up to elucidate the various clinical recurrence patterns of LN-positive PCa and their association with oncologic outcomes.

Design, setting, and participants

Years 1987–2012 of a prospectively maintained institutional RP registry were queried for men with LN-positive PCa at RP. Clinical recurrences were categorized as local, nodal, skeletal, or visceral.

Outcome measurements and statistical analysis

In addition to descriptive statistics and Kaplan-Meier analysis, univariable and multivariable Cox proportional hazards models were constructed to predict recurrence and to quantify the impact of recurrence patterns on cancer-specific mortality (CSM).

Results and limitations

Data from 1011 men with LN-positive PCa at RP were analyzed with 17.6 yr of median follow-up. The 15-yr clinical recurrence rate was 33% (95% confidence interval [CI], 31–35%) for all patients and 52.2% (95% CI, 47.3–57.1%) for patients with biochemical recurrence. The solitary locations were skeletal (n = 94, 55%), nodal (n = 59, 34%), local soft tissue (n = 29, 17%), and visceral (n = 8, 5%). Significant multivariable predictors of recurrence were Gleason score 8–10, number of positive nodes, pathologic Gleason score, and more recent year of surgery. The 15-yr CSM after clinical recurrence was 80%, with a mean overall survival of 30 mo after recurrence. On multivariable analysis, recurrences after 5 yr from RP (hazard ratio [HR]: 0.05), multiple recurrences (HR: 1.97), skeletal (HR: 3.13), and visceral metastases (HR: 7.43) were independently associated with CSM (all p < 0.05).


Recurrences after RP for LN-positive PCa are heterogeneous in terms of time from RP, location, and number of concomitant lesions.

Patient summary

We found that impact of recurrence patterns on cancer-specific mortality varies significantly and allows these patients to be stratified for purposes of prognostication, follow-up, and therapy.

Take Home Message

Recurrences after radical prostatectomy for lymph node–positive prostate cancer vary significantly among patients; however, patients can be stratified by demographic and pathologic characteristics to calculate prognosis and to tailor follow-up and therapeutic strategies according to type of recurrence.

Keywords: Prostate cancer, Lymph node, Recurrence, Metastasis.


a Department of Urology, Mayo Clinic, Rochester, MN, USA

b Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA

c Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA

Corresponding author. Mayo Clinic, Gonda Building 7-130, 200 First Street SW, Rochester, MN 55905, USA. Tel. +1 507 266 9968; Fax: +1 507 284 4951.

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