Clinical Significance of Pathological Lymph Node Status in Prostate Cancer Patients Undergoing Radical Prostatectomy: A 25‐Year Institutional Cohort Study

Abstract

Background While the therapeutic value of pelvic lymph node dissection (PLND) remains controversial, the pathological lymph node status itself may provide important prognostic information after radical prostatectomy (RP). Methods Among 610 consecutive patients who underwent RP between January 2000 and December 2019, with follow‐up through December 2024, we retrospectively analyzed 445 patients with intermediate‐ or high‐risk disease according to the D’Amico classification who underwent PLND. Patients were stratified according to the pathological lymph node status into pN0 (n = 416) and pN1 (n = 29) groups. The primary endpoint was overall survival (OS), and secondary endpoints included biochemical recurrence (BCR) and the prognostic significance of pathological lymph node status. Results The median age of the cohort was 68 years. BCR occurred in 26% of the pN0 patients, with a median time to BCR of 29 months, and in 41% of pN1 patients, with a median time to BCR of 47 months. During follow‐up, 38 all‐cause deaths (9.1%) occurred in the pN0 group and 9 (31.0%) in the pN1 group. Kaplan–Meier analysis showed no significant difference in BCR‐free survival between groups, whereas OS was significantly worse in the pN1 group (hazard ratio: 2.768; 95% confidence interval: 1.315–5.829; p = 0.007). Ten‐year OS rates were 94% for pN0 patients and 74% for pN1 patients. Multivariable analysis identified the pN1 status and postoperative Gleason score of 7 as independent prognostic factors for OS. Conclusions Pathological lymph node positivity is a strong independent predictor of inferior OS in patients undergoing RP for localized prostate cancer. These findings underscore the need for tailored postoperative management strategies in patients with node‐positive disease.