Lymph Node Metastasis Predicts Early Progression and Castration Resistance in Oligometastatic Prostate Cancer after Cytoreductive Radical Prostatectomy.

To evaluate the association between lymph node metastasis (LNM) and clinicopathological features/survival outcomes in oligometastatic prostate cancer (omPCa) patients undergoing cytoreductive radical prostatectomy (cRP) with pelvic lymph node dissection (LND). We retrospectively analyzed 57 omPCa patients undergoing cytoreductive radical prostatectomy (cRP) with LND between 2015 and 2022. Participants were stratified into lymph node-positive (N1, n = 16) and negative (N0, n = 41) groups based on postoperative pathology. Clinicopathological characteristics and survival outcomes were compared between groups. LNM-positive (pN1, n = 16) patients exhibited significantly higher baseline PSA (p = 0.026), Gleason scores (p = 0.013), and T-stage (p < 0.001) than pN0 patients (n = 41). While PSA99 achievement rates were comparable (p = 0.852), pN1 patients had significantly lower rates of undetectable PSA (p < 0.05), shorter median PSA progression-free survival (21 vs. 53 months, p < 0.05), and shorter median CRPC-free survival (26 months vs. unreached, p < 0.05). LNM in omPCa is associated with aggressive tumor biology and predicts inferior survival outcomes despite multimodal therapy. These findings highlight the critical need for improved preoperative nodal staging and intensified adjuvant strategies in pN1 omPCa patients.