Incidence of pelvic lymph node metastasis in radical prostatectomy

Abstract

Radical prostatectomy (RP) provides the best cancer control in patients with clinically prostate gland confined cancer. Multiple models and nomograms combining preoperative prostate-specific antigen (PSA) serum level, clinical stage and Gleason score have been developed to predict the probability of metastatic disease. In prostate cancer (PC) the presence of metastases to the pelvic lymph nodes (PLNs) is recognized widely as an unfavorable prognostic factor. Currently, PLNs dissection is not done in a low-risk group of prostate cancer patients. The aim of this study was to analyze PLN metastases in PC patients, in clinically localized stages of PC. Radical prostatectomy specimens with pelvic lymphadenectomy specimens from 82 PC patients were reviewed. In this group of patients, serum preoperative PSA values ranged from 2 to 23 ng/ml. We diagnosed 11/82 (13.4%) patients with PLN metastases. There were 8 (72%) patients with pT3c pathological stage, and 3 (28%) patients with pT4a stage. PSA below 4 ng/ml was detected in 2/5 (40%) patients with PLN metastases. There was no statistically significant difference between preoperative PSA values and postoperative T stage, and PLN metastases. A statistically significant correlation between PLN metastases and the stage was found in the patients with pT4 and the patients with pT3c PC stages (p < 0.05). Recent RP series indicate PLN metastases to be less than 10%. We demonstrated higher detection of PLN metastases (13.4%) in our RP series. Our results suggest that PLNs dissection should be performed even in patients with low-risk PC.