Reliability of Preoperative Values to Determine the Need for Lymphadenectomy in Patients with Prostate Cancer and Meticulous Lymph Node Dissection

Introduction: The only definite way to determine lymph node metastasis, an unfavorable prognostic factor in prostate cancer is lymphadenectomy. Due to increased morbidity and the increasing trend towards minimally invasive surgery, ways to avoid or at least limit lymphadenectomy are being sought. We...

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Bibliographic Details
Published in:European urology 2002-08, Vol.42 (2), p.84-92
Main Authors: Burkhard, Fiona C, Bader, Pia, Schneider, Eric, Markwalder, Regula, Studer, Urs E
Format: Article
Language:English
Subjects:
Adult
Aged
Gleason score
Grading
Humans
Lymph Node Excision
Lymph node metastasis
Lymphadenectomy
Lymphatic Metastasis - diagnosis
Male
Middle Aged
Predictive Value of Tests
Preoperative Care
Prognosis
Prostate cancer
Prostate-Specific Antigen - blood
Prostatectomy
Prostatic Neoplasms - pathology
Prostatic Neoplasms - surgery
PSA
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Summary:Introduction: The only definite way to determine lymph node metastasis, an unfavorable prognostic factor in prostate cancer is lymphadenectomy. Due to increased morbidity and the increasing trend towards minimally invasive surgery, ways to avoid or at least limit lymphadenectomy are being sought. We routinely performed a meticulous lymphadenectomy in all patients and the goal of this study was to evaluate which of the previously proposed criteria determining who needs a lymphadenectomy can be applied in our patients. Patients and Methods: Patients with clinically localized prostate cancer confirmed by fine needle aspiration cytology, without neoadjuvant hormone therapy, negative pelvic and abdominal CT scans and negative bone scan underwent a radical prostatectomy with simultaneous bilateral extended lymphadenectomy. Results: Between 1989 and 1999, 463 patients were included in this study. The median age was 64 (range 44–76) years and the median PSA was 11.0 (range 0.42–172) ng/ml. A median of 21 nodes were removed per patient. One hundred and nine (24%) had lymph node metastasis: 17% of patients with a PSA value ≤20 ng/ml and 12% with a PSA value ≤10 ng/ml. None of the patients with a preoperative grading of 1 and a PSA value ≤10 ng/ml and 10% of the “low-risk patients” with a PSA value ≤10 ng/ml and a preoperative grading
ISSN:0302-2838
1873-7560
DOI:10.1016/S0302-2838(02)00243-9