Adult urologyCritical Assessment of Ideal Nodal Yield at Pelvic Lymphadenectomy to Accurately Diagnose Prostate Cancer Nodal Metastasis in Patients Undergoing Radical Retropubic Prostatectomy
Section snippets
Material and methods
From November 2002 to August 2005, 944 patients underwent radical retropubic prostatectomy and PLND for localized prostate cancer at a single institution. Of these 944 patients, 31 were excluded because of incomplete pathologic information, 34 because PLND was not performed, and 21 because they had a prostate-specific antigen (PSA) level greater than 50 ng/mL, which is highly suggestive of metastatic disease.11 Thus, 858 patients were included in this study. No patient had received any
Results
The patient age was 45 to 85 years (mean age ± SD 66.6 ± 7.3). The clinical stage was T1c in 474 (55.2%), T2 in 349 (40.7%), T3 in 34 (4.0%), and missing in 1 (0.1%) of 858 patients. The biopsy Gleason sum was 6 or less in 534 patients (62.2%), 7 in 215 (25.1%), 8 to 10 in 70 (8.2%), and missing in 39 patients (4.5%; Table 1). The PSA level was 0.2 to 49.9 ng/mL (mean 9.1, median 5.8). LNI was diagnosed in 88 patients (10.3%). The number of removed and examined nodes ranged from 2 to 40 (median
Comment
Several studies have suggested that more extensive PLND could be associated with a greater incidence of positive nodes.2, 3, 4, 5 ePLND, with a mean of 17.8 lymph nodes removed, was associated with a threefold greater LNI rate compared with modified PLND (mean 9.3 lymph nodes removed; 23% versus 7%; P = 0.02).5 However, the link between PLND extent and LNI has not always been confirmed. In one randomized trial, ePLND did not yield a greater rate of positive nodes (ePLND 3.2% versus limited PLND
Conclusions
Taken together, our data have indicated that the nodal yield at PLND is directly related to the LNI rate. A greater nodal yield is associated with superior staging accuracy. PLNDs in which fewer than 10 nodes are obtained should probably be omitted, because the probability of finding positive lymph nodes is very limited. The practical application of more accurate LNI diagnosis in patients with prostate cancer may allow more timely administration of systemic therapy and may result in better
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