Intraprostatic tumor location and pelvic lymph node metastatic pattern in early prostate cancer

Recently we treated 54 patients with clinically localized prostate cancer: 8 had Stage A disease, 13 had Stage B1, 32 Stage B2, and 1 Stage C. Fifty of these patients underwent bilateral pelvic lymphadenectomy and retropubic radical prostatectomy, while the other 4 patients underwent bilateral pelvic lymphadenectomy only. Pathologic staging revealed pelvic lymph node metastases in 12 patients. We reviewed these 12 Stage D1 cases to see whether or not the intraprostatic tumor location influenced the locoregional metastatic nodal pattern. We found that metastases occurred ipsilaterally in 5 cases, while the other 7 patients experienced bilateral pelvic involvement. We failed to find any case in which contralateral nodal involvement occurred without the tumor also involving the pelvic lymph nodes ipsilateral to the intraprostatic tumor. The data suggest that it would be reasonable to perform pelvic lymphadenectomy only on the same side of the prostatic lesion. This modified approach potentially could reduce morbidity and cost to the patient.