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Is pelvic lymph node dissection necessary in patients with biopsy proven Gleason 6 prostate cancer? - analysis of the
Michael Daugherty1, Dillon Sedaghatpour, Gennady Bratslavsky
1Department of Urology, SUNY Upstate Medical University, Syracuse, New York, USA.
Introduction:
Since the advent of prostate-specific antigen (PSA) screening there has been a decreased incidence of lymph node positive disease (LND). Nevertheless, because of possible upgrading, LND is frequently performed with preoperative Gleason 6 prostate cancer. We utilized the Surveillance Epidemiology and End Results (SEER) database to evaluate the frequency of LND and preoperative variables for node positivity in contemporary patients with preoperative Gleason 6 disease.
Materials And Methods:
SEER-18 registries database was queried for all patients diagnosed with prostate cancer between the years 2010 and 2014. Patients were excluded that had unknown histology or unknown preoperative or postoperative Gleason score. We evaluated the rate of LND, Gleason upgrading, and node positive events.
Results:
There were 16,544 patients with preoperative Gleason 6 disease that met our inclusion criteria. Of these, 35.4% (5,856 patients) had LND and 64.6% (10,688 patients) did not. Gleason upgrade on final pathology was found in 51.9% and 45.0% of the LND and no LND cohorts, respectively. There were only 62 (1.1%) patients with node positive disease following LND. These patients had higher preoperative PSA and clinical stage disease.
Conclusion:
In a contemporary cohort of patients with preoperative Gleason 6 prostate cancer LND continues to be performed in about 35% of cases. Despite significant rate of Gleason upgrading on final pathology, only 1% will have node positive disease. With available data on morbidity of LND, the LND for preoperative Gleason 6 prostate in contemporary PSA screened cancer cohorts is likely not warranted.
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