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Is there a need for pelvic lymph node dissection in low risk prostate cancer patients prior to definitive local therapy?

Authors :
Weckermann D
Wawroschek F
Harzmann R
Source :
European urology [Eur Urol] 2005 Jan; Vol. 47 (1), pp. 45-50; discussion 50-1.
Publication Year :
2005

Abstract

Objectives: In men with low risk prostate cancer the need for pelvic lymph node dissection is controversial. Therefore, we examined how many men with favorable preoperative risk factors had positive lymph nodes.<br />Methods: 235 men with preoperative PSA < or =10 ng/ml, Gleason score < or =6 and positive biopsies in only one lobe, had radio-guided pelvic sentinel lymph node (SLN) dissection and radical retropubic prostatectomy (RRP) or-in case of no positive lymph nodes detected-a transperineal I(125) seed implantation. Eighty-four men with positive biopsies in both lobes and identical PSA and Gleason score had SLN dissection and RRP.<br />Results: In 187 men with positive biopsies in one lobe RRP was performed. Sixteen patients had positive lymph nodes. Median 6 SLN (mean 6.8) and 6 non-sentinel lymph nodes (NSLN) (mean 7.3) were dissected. All men with positive lymph nodes also had positive SLN. Eighty-four men with positive biopsies in both lobes had RRP. Nine men had positive lymph nodes (10.7%). A median of 6 SLN (mean 6.6) and 5 NSLN (mean 7.5) were dissected. All men with positive nodes had a single positive SLN.<br />Conclusions: In patients with PSA < or =10 ng/ml and biopsy Gleason score < or =6, positive lymph nodes were identified by radio-guided surgery in 6.8% (positive biopsies in one lobe) and 10.7% (positive biopsies in both lobes). Up to 4 positive SLN were found. Therefore, we suggest not to dispense with an operative lymph node staging, even in low risk disease.

Details

Language :
English
ISSN :
0302-2838
Volume :
47
Issue :
1
Database :
MEDLINE
Journal :
European urology
Publication Type :
Academic Journal
Accession number :
15582248
Full Text :
https://doi.org/10.1016/j.eururo.2004.07.017