Title: Features and management of men with pN1 cM0 prostate cancer after radical prostatectomy and lymphadenectomy: a systematic review of population-based evidence.

: Introduction: Up to 15% of prostate cancer (PCa) patients harbour lymph node invasion (pN+) at radical prostatectomy (RP) plus lymph node dissection. Nonetheless, the optimal management strategy in this setting is not well characterized so far. We aimed to investigate the features and optimal management of pN+ cM0 PCa according to registry based studies. Methods : We performed a systematic review in January 2020 following the PRISMA criteria - Web (Embase, Medline and others) and manual search. Results: Overall, n=13 studies were identified. In population-based studies, the pN+ prevalence was 2.6% (25,114/954,416). Management strategies comprised 13,536 men undergoing observation, 11,149 adjuvant androgen deprivation therapy (aADT), 7,075 adjuvant radiotherapy (aRT) +aADT and 705 aRT. Baseline features showed aggressive PCa in the majority of men (53.1% Gleason≥8; 85.1% pT≥3; 50.1% PSM). At a median follow -up ranging from 48 to 134 months, Cancer-related death was 5% and overall mortality 16.6%. aADT and aRT alone had no

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