393 THE NUMBER OF PELVIC LYMPH NODES REMOVED AT RADICAL RETROPUBIC PROSTATECTOMY AFFECTS THE RATE OF NODAL INVOLVEMENT IN ALL RISK CATEGORIES OF PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Staging III1 Apr 2010393 THE NUMBER OF PELVIC LYMPH NODES REMOVED AT RADICAL RETROPUBIC PROSTATECTOMY AFFECTS THE RATE OF NODAL INVOLVEMENT IN ALL RISK CATEGORIES OF PROSTATE CANCER Giuseppe Campo, Cesare Selli, Chiara Mariani, Paolo Casale, Michele Andreuccetti, Giorgio Pomara, and Francesco Francesca Giuseppe CampoGiuseppe Campo More articles by this author , Cesare SelliCesare Selli More articles by this author , Chiara MarianiChiara Mariani More articles by this author , Paolo CasalePaolo Casale More articles by this author , Michele AndreuccettiMichele Andreuccetti More articles by this author , Giorgio PomaraGiorgio Pomara More articles by this author , and Francesco FrancescaFrancesco Francesca More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.462AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Pelvic lymph node dissection (PLND) is considered the most reliable procedure for the detection of lymph node metastases in prostate cancer (PCa). The need for PLND has been questioned in patients with low risk tumors, due to the negligible rate of lymph node involvement (LNI) in such group. The purpose of this study was to evaluate the association between the number of lymph nodes removed with the presence of LNI in patients with low, intermediate and high risk PCa. METHODS The study cohort included 1131 consecutive patients treated with radical retropubic prostatectomy (RRP) and PLND for clinically localized prostate cancer. Patients were divided into three groups according to the number of lymph nodes removed (LnR): ≤ 9 LnR, 10-19 LnR, ≥20 LnR and into three risk groups: low risk (T1c, PSA<10 ng/ml and biopsy Gleason sum ≤6), high risk (PSA>20 ng/ml or cT3 or biopsy Gleason sum ≥8) and intermediate risk (all the remaining). The probability of finding LNI according to the number of removed lymph nodes and for each risk group was analyzed RESULTS Overall, 423 (37.4%), 588 (52%) and 120 (10.6%) patients had low, intermediate and high risk prostate cancer, respectively. 351 (31%), 509 (45%) and 271 (24%) patients had ≤ 9 LnR, 10-19 LnR, ≥20 LnR respectively. Mean PSA was 11.8 ng/ml (Range 0.34-220). Biopsy Gleason sum was 2-6, 7 and 8-10 in 450 (39.8%), 559 (49.4%), 122 (10.8%) of patients. Overall, 98 (9%) patients had LNI, which was found in 4.5%, 10.5% and 14.2% of patients with low, intermediate and high risk prostate cancer, respectively (p<0.0001). LNI was found in 5.1%, 7.5% and 15.5% of patients with ≤ 9 LnR, 10-19 LnR, ≥20 LnR, respectively (p<0.0004). Overall, a mean of 14.2 lymph nodes were removed and examined. The mean number of nodes removed did not differ among the different risk groups (13.9, 14.2 and 14.9 in low, intermediate and high risk groups, respectively; p=ns).The removal of 20 lymph nodes or more yielded a significant increase of LNI detection: 11.2%, 15.7% and 27.7% in patients with low, intermediate and high risk prostate cancer, respectively. On the other hand, assessment of 9 or fewer nodes was associated with a significant reduction of finding LNI in all risk categories: 0 %, 9.1% and 8.8 % (low, intermediate and high risk prostate cancer, respectively). CONCLUSIONS The number of lymph nodes surgically removed is significantly associated with the presence of LNI in patients with low, intermediate and high risk prostate cancer. Therefore, if a staging PLND is contemplated, this should be extended, even in the low risk group Pisa, Italy© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e156 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giuseppe Campo More articles by this author Cesare Selli More articles by this author Chiara Mariani More articles by this author Paolo Casale More articles by this author Michele Andreuccetti More articles by this author Giorgio Pomara More articles by this author Francesco Francesca More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...