1339 LIMITED PELVIC LYMPHADENECTOMY IS NOT SUFFICIENT FOR STAGING IN HIGH RISK PROSTATE CANCER PATIENTS

Abstract

You have accessJournal of UrologyProstate Cancer: Localized VI1 Apr 20121339 LIMITED PELVIC LYMPHADENECTOMY IS NOT SUFFICIENT FOR STAGING IN HIGH RISK PROSTATE CANCER PATIENTS Senji Hoshi, Natuho Hayashi, Yuuta Kurota, Kiyotugu Hoshi, Akinori Muto, Kenji Numahata, and Osamu Sugano Senji HoshiSenji Hoshi Yamagata, Japan More articles by this author , Natuho HayashiNatuho Hayashi Yamagata, Japan More articles by this author , Yuuta KurotaYuuta Kurota Yamagata, Japan More articles by this author , Kiyotugu HoshiKiyotugu Hoshi Yamagata, Japan More articles by this author , Akinori MutoAkinori Muto Yamagata, Japan More articles by this author , Kenji NumahataKenji Numahata Yamagata, Japan More articles by this author , and Osamu SuganoOsamu Sugano Yamagata, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1721AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lymphadenectomy for prostate cancer is limited to obturator lymph nodes, although the internal and external lymph nodes represent the primary landing zone of lymphatic drainage. We performed anatomically adequate extended pelvic lymphadenectomy to assess the incidence of lymph node metastasis in cases of clinically localized prostate cancer. METHODS A total of 124 consecutive patients underwent extended pelvic lymphadenectomy at radical retropubic prostatectomy comprising 8 selective fields, namely the external iliac, internal iliac, obturator and common iliac lymph nodes bilaterally. Histopathological findings were compared with serum prostate specific antigen (PSA), histopathological stage, preoperative biopsy and postoperative prostatectomy Gleason score. Extended pelvic lymphadenectomy was compared with radical retropubic prostatectomy and standard lymphadenectomy in 700 consecutive patients in terms of complications, the number of lymph nodes dissected and operative time. RESULTS There were no significant differences in age, preoperative PSA or mean biopsy Gleason score in patients who underwent extended pelvic and standard lymphadenectomy. Metastases were diagnosed in 26 of the 124 patients (21%) and in 25 of the 100 high risk patients (25%) who underwent the extended procedure. A mean of 22 lymph nodes (range 15 to 31) were dissected. Metastases were identified in the internal iliac and external regions despite negative obturator lymph nodes. In 25 of the 26 patients (96.2%) with lymph node metastasis PSA was greater than 10.5 ng./ml and preoperative biopsy Gleason sum was 7 or greater. A intermediate risk of 2% for lymph node disease was noted in patients with serum PSA6.7 ng./ml. and biopsy Gleason score 4+3. There were no significant differences in regard to intraoperative and postoperative complications, lymphocele formation or blood loss in the 2 groups. CONCLUSIONS Extended pelvic lymphadenectomy is associated with a high rate of lymph node metastasis outside of the fields of standard lymphadenectomy in cases of clinically localized prostate cancer. Lymphadenectomy including the internal and external iliac lymph nodes should be performed in all patients with prostate cancer who are at high risk for lymph node involvement, as indicated by PSA greater than 10.5 ng./ml. and biopsy Gleason sum 7 or greater. In the low risk group pelvic lymphadenectomy can be omitted. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e543 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Senji Hoshi Yamagata, Japan More articles by this author Natuho Hayashi Yamagata, Japan More articles by this author Yuuta Kurota Yamagata, Japan More articles by this author Kiyotugu Hoshi Yamagata, Japan More articles by this author Akinori Muto Yamagata, Japan More articles by this author Kenji Numahata Yamagata, Japan More articles by this author Osamu Sugano Yamagata, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...