Elsevier

Urology

Volume 45, Issue 2, February 1995, Pages 270-274
Urology

Adult urology
Pelvic lymphadenectomy can be omitted in selected patients with carcinoma of the prostate: development of a system of patient selection

https://doi.org/10.1016/0090-4295(95)80017-4Get rights and content

Abstract

Objectives. The prevalence of pelvic lymph node metastases in men with clinically localized prostate cancer has decreased dramatically over the past decade, possibly due to efforts at early detection. With a significantly lower incidence of pelvic node involvement, it may be possible to identify a segment of patients for whom pelvic lymph node dissection (PLND) may be omitted. This study was conducted to develop a method to select patients for whom PLND could be omitted.

Methods. We analyzed serum prostate-specific antigen (PSA), clinical stage, biopsy Gleason score, and final pathologic stage in 481 men with clinically localized prostate cancer. These variables were compared to the risk of positive pelvic lymph nodes.

Results. Logistic regression analysis determined that combining all three variables provided the best determination of final pathologic stage. A series of probability curves have been created to estimate the risk of positive lymph nodes in a given patient. Based on the distribution of patients in this study and using these probability functions, PLND could be avoided in up to 50% of patients with localized prostate cancer diagnosed by contemporary methods.

Conclusions. In properly selected patients, pelvic lymphadenectomy can be omitted in the staging and treatment of localized prostate cancer.

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The opinions or assertions contained herein are the private views of the authors and are not to be construed as reflecting the views of the Departments of the Army, Air Force, or Defense.

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