Role of Bilateral Pelvic Lymphadenectomy in Prostatic Cancer

Abstract

Objectives: to identify a group of patients with prostate cancer for whom open staging pelvic lymph node dissection (PLND) could be superfluous. Methods: the medical records of all patients presenting with prostate cancer from January 1992 to December 1996 were reviewed. A total of 118 patients with clinically localized disease were selected to undergo radical retropubic prostatectomy (RRP) preceded by open PLND. Final nodal status was correlated with the value of the preoperative serum prostate specific antigen (PSA) concentration, clinical stage (TNM), and grading (by OMS) to evaluate the predictivity of nodal involvement. We identified 3 groups: PSA <10 ng/ml, T1–2, G1-2, = 1st very low risk, PSA 10 −15, T1-2 - G1-2 = 2nd low risk, PSA <15 T3 or G3 or PSA >15 every T and G = 3rd high risk. Results: overall, only 21 patients (18%) had lymph node metastases. Lymph node involvement was significantly correlated with elevated serum PSA values, high grading, and advanced clinical stage. 35 patients belonged to the first 2 groups, presenting with low PSA and favorable clinical stage and grade, none with lymph node involvement. These patients could have avoided PLND with a very low risk of missing something. Conclusions: open staging PLND may no longer be justified on a routine basis in patients undergoing radical retropubic prostatectomy.