Assessment of Lymph Node Invasion and Associated Risk Factors in Intermediate-Risk Prostate Cancer: A Retrospective...

Prostate cancer (PCa) remains one of the most common malignancies among men worldwide, with lymph node invasion (LNI) serving as a critical prognostic factor influencing treatment decisions and outcomes. This study aimed to evaluate the prevalence of LNI and investigate associated risk factors in a cohort of intermediate-risk PCa patients.

This retrospective cross-sectional study included intermediate-risk PCa patients treated at Imam Khomeini Hospital, Tehran, Iran, from 2019 to 2024, who underwent radical prostatectomy with pelvic lymph node dissection (PLND). Data were extracted from hospital clinical documents and compared between patients with and without LNI. The primary outcome was the prevalence of LNI, while the secondary outcome aimed to identify associated demographic, clinical, and pathological risk factors. Statistical tests such as univariate logistic regression and ROC curve analysis were used.

This study found a 12.10% prevalence of LNI. Univariate analysis revealed significant associations between LNI and advanced clinical stage, higher Gleason score, greater core involvement, and elevated total prostate-specific antigen (PSA) (OR=1.33), with all P<0.05. In multiple logistic regression analysis, adjusting for confounders, only PSA remained an independent predictor. The receiver operating characteristic (ROC) analysis confirmed PSA's moderate diagnostic accuracy for LNI (area under the curve [AUC]=0.685, P<0.001), with an optimal cut-off of 16.52 ng/mL, 65% sensitivity, and 68% specificity.

The results indicated that only total PSA remained an independent predictor. This finding highlighted total PSA as a key biomarker for assessing LNI risk in intermediate-risk PCa patients. Additionally, total PSA demonstrated moderate diagnostic accuracy in predicting LNI, supporting its clinical utility in risk stratification and decision-making.