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Sentinel lymph node dissection for prostate cancer: experience with more than 1,000 patients
Dorothea Weckermann1, Robert Dorn, M Trefz
1Department of Urology, Klinikum Augsburg, Augsburg, Germany. dorothea.weckermann@uro.augsburg-med.de
The Journal of Urology
|February 14, 2007
Summary
More than half of prostate cancer patients undergoing lymph node dissection have positive nodes outside standard areas. Extended dissection is recommended, especially if sentinel nodes are positive, to detect cancer spread.
Area of Science:
- Urology
- Oncology
- Surgical Pathology
Background:
- Prostate cancer management often involves assessing pelvic lymph node status.
- Radical retropubic prostatectomy is a common treatment for localized prostate cancer.
Purpose of the Study:
- To determine the incidence of positive pelvic lymph nodes in men undergoing radical retropubic prostatectomy.
- To correlate lymph node positivity with prostate-specific antigen (PSA), Gleason score, and pathological stage.
- To investigate the distribution of tumor cells within sentinel and non-sentinel lymph nodes.
Main Methods:
- Radio-guided pelvic lymph node dissection and radical retropubic prostatectomy were performed on 1,055 men.
- Sentinel lymph node removal was standard for men with PSA ≤ 20 ng/ml and Gleason score ≤ 7.
- Extended pelvic lymph node dissection was performed for men with PSA > 20 ng/ml or Gleason score > 7.
Main Results:
- Positive lymph nodes were identified in 19.6% of patients (207 men).
- In 63.3% of these cases, positive nodes were located outside the standard lymphadenectomy region.
- Higher PSA, pathological stage, and Gleason grade correlated significantly with positive sentinel and non-sentinel lymph nodes (p<0.001).
Conclusions:
- Sentinel or extended pelvic lymphadenectomy should be considered during prostatectomy due to the high incidence of positive nodes outside standard dissection areas.
- Extended lymph node dissection is crucial in cases with positive sentinel nodes, as tumor cells are often found in non-sentinel nodes.
