292 RADIO-GUIDED SENTINEL LYMPH NODE DISSECTION IN OVER 1,200 CASES WITH PROSTATE CANCER: RATE OF LYMPH NODE POSITIVE PATIENTS DEPENDING ON PREOPERATIVE PROGNOSTIC FACTORS

Abstract

INTRODUCTION AND OBJECTIVES: The pelvic lymphadenectomy (PLND) is currently the most reliable staging method for the detection of lymph node (LN) metastases in clinically localized prostate cancer. Any limitation of the dissection area decreased the sensitivity of detection of metastases. Therefore the European (EAU) guidelines recommend an extended or sentinel-guided PLND (SLND) at least for patients with intermediate or high risk disease. Based on this we analyzed the rate of LN positive (LN ) patients detected by SLND depending on preoperative prognostic factors and opposed them to nomogram data and the EAU guidelines. METHODS: We included 1,233 patients who had received a SLND and a radical retropubic prostatectomy (01/2005 – 12/2009). The average number of removed LN was determined. The rate of LN patients was analysed total, for low risk (PSA 10, Gleason-Score (G.-S.) 6 / T2a), intermediate risk (PSA 10 20 and/or G.-S. 7 and/or T2b) and high risk (PSA 20 and/or G.-S. 8–10 and/or T2c) prostate cancer. The results were compared with the partin tables and the recommendations of the EAU guidelines (no PLND: PSA 20 / G.-S. 6 / T2). RESULTS: An average of 10 LN was removed. 17.4% of the patients had LN metastases. The rate of LN patients were distributed as follows: low risk (n 436) 3.2%, intermediate risk (n 446) 14.8% and high risk prostate cancer (n 351) 38.2%. According to the partin tables one would have expected much less LN patients particularly in the low and high risk situation (Table 1). According to the EAU guideline 6.1% LN patients would not have been detected. In the cT2 tumors of this collective even 12.1% patients with LN metastases would not have been found. CONCLUSIONS: Because of their high sensitivity the SLND is regarded as optional to the extended PLND in the EAU guidelines. In our collective in all risk situations more LN patients were detected by SLND than expected according to the partin tables. In view of 12.1% LN patients in cT2 tumors which are not provide for a PLND in the EAU guidelines we consider the SLND even in such cases. The SLND offers a relative low expenditure and a minimal morbidity, without having to expect a significantly reduced detection of metastases.