185 MODELS ASSESSING THE NEED FOR PELVIC LYMPH NODE DISSECTION CANNOT BE RELIABLY USED IN MEN WITH PROSTATE CANCER PREVIOUSLY TREATED WITH SURGERY FOR BENIGN PROSTATIC ENLARGEMENT

Abstract

You have accessJournal of UrologyProstate Cancer: Staging I1 Apr 2012185 MODELS ASSESSING THE NEED FOR PELVIC LYMPH NODE DISSECTION CANNOT BE RELIABLY USED IN MEN WITH PROSTATE CANCER PREVIOUSLY TREATED WITH SURGERY FOR BENIGN PROSTATIC ENLARGEMENT Umberto Capitanio, Alberto Briganti, Nazareno Suardi, Andrea Gallina, Firas Abdollah, Fabio Castiglione, Giulia Castagna, Alessandro Nini, Paolo Dell'Oglio, Paolo Capogrosso, Valerio Di Girolamo, Giorgio Guazzoni, Patrizio Rigatti, and Francesco Montorsi Umberto CapitanioUmberto Capitanio Milan, Italy More articles by this author , Alberto BrigantiAlberto Briganti Milan, Italy More articles by this author , Nazareno SuardiNazareno Suardi Milan, Italy More articles by this author , Andrea GallinaAndrea Gallina Milan, Italy More articles by this author , Firas AbdollahFiras Abdollah Milan, Italy More articles by this author , Fabio CastiglioneFabio Castiglione Milan, Italy More articles by this author , Giulia CastagnaGiulia Castagna Milan, Italy More articles by this author , Alessandro NiniAlessandro Nini Milan, Italy More articles by this author , Paolo Dell'OglioPaolo Dell'Oglio Milan, Italy More articles by this author , Paolo CapogrossoPaolo Capogrosso Milan, Italy More articles by this author , Valerio Di GirolamoValerio Di Girolamo Milan, Italy More articles by this author , Giorgio GuazzoniGiorgio Guazzoni Milan, Italy More articles by this author , Patrizio RigattiPatrizio Rigatti Milan, Italy More articles by this author , and Francesco MontorsiFrancesco Montorsi Milan, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.237AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We evaluated the effect of previous prostate surgery performed for lower urinary tract symptoms (SxLUTS) on the ability to predict lymph node invasion (LNI) in patients subsequently diagnosed with prostate cancer using two widely used LNI predictive models. METHODS From January 1985 to January 2011, we collected data on 5833 patients with clinical T1-T3 PCa treated with radical prostatectomy (RP) and extended pelvic lymph node dissection (eLND). Of these 292 (5.0%) had previously undergone SxLUTS. Cagiannos et al. (J Urol 2003;170:1798–1803) and Briganti et al. (Eur Urol 2006;49:1019-1026) nomograms predicting LNI were externally validated in patients previously treated with SxLUTS and in naïve patients, respectively. The accuracy of each model was tested using the area under the receiver operating characteristics (ROC) curve. Two-hundred bootstrap resamples were used to reduce overfit bias. RESULTS The rate of LNI was 13.5 in naïve patients vs. 9.9% in patients treated with previous SxLUTS (p=0.08). Mean number of lymph nodes removed was 18.7 vs. 17.5 in naïve patients vs. SxLUTS patients (p=0.09). PSA levels at RP was 13.0 vs. 8.2 ng/ml in naïve vs. SxLUTS patients (p<0.001). Clinical stage resulted cT1c in 53.4 vs. 61.5%, cT2 in 34.1 vs. 29.7%, cT3 in 12.5 vs. 8.8% in naïve vs. SxLUTS patients, respectively (p=0.04). Conversely, no significant differences were found between the two groups in terms of biopsy Gleason score (6, 7 and 8-10: 62.3, 28.3 and 9.4% vs. 61.0, 29.4 and 9.6%, p=0.9) as well as percentage of positive cores distribution (42.4 vs. 46.9% in naïve patients vs. SxLUTS patients, respectively; p=0.09). Overall, at multivariable analyses, PSA, clinical stage, biopsy Gleason score and percentage of positive cores achieved an independent predictor status for LNI prediction (all p<0.03). Cagiannos et al. and Briganti et al. LNI nomograms provided more accurate prediction in naïve patients relative to patients previously treated with SxLUTS (externally validated AUC: 86.8 and 87.6% vs. 72.8 and 69.9%, p<0.001). CONCLUSIONS When counseling patients diagnosed with prostate cancer, clinicians should be aware that the accuracy of nomograms predicting lymph node invasion significantly decreases if patients previously underwent prostatic surgery. Therefore, novel models are needed for the prediction of LNI in this patient category. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e78 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Umberto Capitanio Milan, Italy More articles by this author Alberto Briganti Milan, Italy More articles by this author Nazareno Suardi Milan, Italy More articles by this author Andrea Gallina Milan, Italy More articles by this author Firas Abdollah Milan, Italy More articles by this author Fabio Castiglione Milan, Italy More articles by this author Giulia Castagna Milan, Italy More articles by this author Alessandro Nini Milan, Italy More articles by this author Paolo Dell'Oglio Milan, Italy More articles by this author Paolo Capogrosso Milan, Italy More articles by this author Valerio Di Girolamo Milan, Italy More articles by this author Giorgio Guazzoni Milan, Italy More articles by this author Patrizio Rigatti Milan, Italy More articles by this author Francesco Montorsi Milan, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...