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Metastatic Involvement of the Prostatic Anterior Fat Pad: Implications for the Pathologist

Nicolas Lopez-Hisijos1, Iskender Genco1, Alex Gorbonos2

  • 1Department of Pathology, Loyola University Medical Center, Maywood, IL.

American Journal of Clinical Pathology
|June 13, 2018
PubMed
Abstract

Insights

Pathologic evaluation of the prostatic anterior fat pad (PAFP) can detect lymph node involvement, even in patients with a low risk of recurrence. This analysis may alter cancer staging and treatment strategies.

Area of Science:

  • Urology
  • Pathology
  • Oncology

Background:

  • The utility of evaluating the prostatic anterior fat pad (PAFP) in patients with a low preoperative probability of recurrence is not well-established.
  • Accurate staging is crucial for guiding treatment decisions in prostate cancer management.

Purpose of the Study:

  • To determine the diagnostic value of pathological examination of the PAFP.
  • To assess the significance of PAFP evaluation in patients with a low risk of prostate cancer recurrence.

Main Methods:

  • Retrospective analysis of radical prostatectomy (RP) specimens from a tertiary care academic center.
  • Review of 602 RP specimens collected between 2009 and 2017.
  • Identification of PAFP presence and assessment for lymph node involvement (LNI).

Main Results:

  • The PAFP was included in 70% (420 of 602) of RP specimens analyzed.
  • Lymph node involvement (LNI) was detected in the PAFP in 1% (4 of 420) of cases.
  • In two cases, PAFP LNI was the sole site of metastasis; one occurred in a patient with low recurrence probability and involved a nonpalpable PAFP lymph node.

Conclusions:

  • Pathological examination of the PAFP can be valuable, even in patients with a low preoperative probability of recurrence.
  • Detection of metastatic involvement in small PAFP lymph nodes can potentially alter patient staging.
  • PAFP evaluation may refine treatment strategies by identifying unexpected metastatic disease.

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