gms | German Medical Science

27th German Cancer Congress Berlin 2006

German Cancer Society (Frankfurt/M.)

22. - 26.03.2006, Berlin

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The risk of lymph node metastasis in patients with low risk prostate cancer undergoing radical prostatectomy

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  • corresponding author presenting/speaker Axel Heidenreich - Bereich Urologische Onkologie Universitätsklinikum Köln, Deutschland
  • Carsten Ohlmann - Bereich Urologische Onkologie Universitätsklinikum Köln
  • Udo H. Engelmann - Bereich Urologische Onkologie Universitätsklinikum Köln
  • Martin Schumacher - Urologische Universitätsklinik, Bern
  • Urs E. Studer - Urologische Universitätsklinik, Bern

27. Deutscher Krebskongress. Berlin, 22.-26.03.2006. Düsseldorf, Köln: German Medical Science; 2006. DocPO296

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dkk2006/06dkk406.shtml

Published: March 20, 2006

© 2006 Heidenreich et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Introduction: The necessity and the anatomical extent of pelvic lymphadenectomy (PLA) in patients undergoing radical prostatectomy (RRP) remains a matter of debate. Especially, in patients with favourable preoperative predictors (PSA < 10ng/ml, Gleason score ≤ 6 and cT1c PCA), PLA often is omitted due to the potentially low risk of lymph node metastases predicted by preoperative nomograms. It is the aim of our retrospective analysis to evaluate the frequency and location of lymph node metastases and to analyse the predictive accuracy of preoperative nomograms such as Partin tables, CART analysis in a cohort of men with clinically localized PCA.

Patients & Methods: 784 patients with cT1c PCA, a preoperative PSA < 10ng/ml and a biopsy Gleason score ≤ 6 underwent RRP with extended PLA (EPLA). None of the patients received neoadjuvant androgen deprivation therapy. EPLA comprises the lymphatic tissue around the external, internal and common iliac artery up to the ureteral crossing as well as the obturator fossa. Lymphatic tissue was sent for pathohistological examination in separate packages. Postoperative data were correlated with the calculated risk of lymph node involvement as predicted by the Partin tables and CART analysis.

Results: A median of 20 (1-72) lymph nodes were removed per patient. A total of 44 patients (5.6%) were diagnosed with pelvic lymph node metastases. 19 patients (43.2%) harboured 1 positive lymph node, 15 (34.1%) and 10 (22.7%) patients exhibited 2 or ≥ 2 positive lymph nodes, respectively. 10 (25%) patients demonstrated positive nodes only around the internal iliac artery. 75 (13%) and 494 (87%) patients demonstrated biopsy Gleason score 2-4 and 5-6 PCA, respectively. Positive lymph nodes were identified in 4/75 (5.3%) and in 40/494 (8.1%) of these patients. The predicted risk of lymph node involvement according to the Partin tables was 0% for a biopsy Gleason score of 2-4 and 2% for a biopsy Gleason score 5-6; the predicted by the application of CART analysis was 2.2%.

Discussion: EPLA in patients undergoing RRP for clinically localized PCA reveals positive node metastases in 5% of the patients. Tailoring the indication for EPLA by the use of Partin tables and CART analysis would have missed 34/44 (77%) patients with pN1 disease.