Risk factors for lymph node metastasis in a contemporary radical prostatectomy cohort

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• Accurate prediction of lymph node metastasis (LN+) in prostate cancer is crucial for treatment planning.
• Radical prostatectomy (RP) specimens provide valuable data for understanding factors associated with LN+.

Purpose of the Study:

• To assess the relationship between clinicopathologic factors and regional lymph node metastasis (LN+) in patients undergoing radical prostatectomy (RP).
• Key factors investigated include Grade Group (GG), tumor volume (TV), prostate-specific antigen density (PSAD), pathologic stage, and tumor topography.

Main Methods:

• A cohort of treatment-naive RPs from 2013-2026 was reviewed with centralized histologic assessment.
• Grade Group (GG) and tumor volume (TV) were determined. Prostate-specific antigen density (PSAD) was calculated.
• Multivariable Firth penalized logistic regression was used to identify factors associated with LN+.

Main Results:

• No lymph node metastasis (LN+) was observed in Grade Group 1 (GG1) prostate cancer cases.
• In GG2-GG5 cancers, LN+ was associated with increasing GG, larger TV, higher PSAD, pT3a/pT3b stage, and posterior or extensive bilateral tumor topography.
• Anterior tumor topography showed an inverse correlation with LN+.

Conclusions:

• Grade Group (GG) 1 prostate cancer does not metastasize to regional lymph nodes.
• For higher Grade Groups (GG2-GG5), increasing GG, tumor volume (TV), prostate-specific antigen density (PSAD), advanced pathologic stage, and specific tumor locations are independent predictors of lymph node metastasis (LN+).
• Grade Group 5 cancers exhibited a distinct PSAD-TV relationship compared to GG2-GG4 cancers.