Open pelvic lymph node dissection for prostate cancer: a reassessment

Area of Science:

• Urology
• Oncology
• Surgical Pathology

Background:

• Prostate cancer staging is crucial for treatment decisions.
• Pelvic lymph node dissection (PLND) is an established staging procedure.
• The risk-benefit profile of open PLND in radical retropubic prostatectomy (RRP) requires evaluation.

Purpose of the Study:

• To conduct a risk-to-benefit analysis of open staging pelvic lymph node dissection (PLND) in prostate cancer patients.
• To assess the diagnostic yield and morbidity of PLND in the context of RRP.

Main Methods:

• Retrospective review of 245 patients with clinically localized prostate cancer undergoing RRP with open PLND (July 1989-April 1994).
• Univariate and multivariate analyses to correlate preoperative factors (PSA, clinical stage, Gleason score) with nodal status.
• Evaluation of costs and complications associated with PLND.

Main Results:

• Only 6.5% of patients had lymph node metastases.
• Metastases significantly correlated with elevated PSA, high Gleason score, and advanced clinical stage.
• Low-risk patients (nonpalpable tumors, PSA < 10, Gleason < 6) had a metastasis rate of only 2.2% (4/179).
• Complications occurred in 4.1% of patients; cost per metastasis diagnosed in low-risk cases was ~$43,600.

Conclusions:

• Routine open staging PLND may not be routinely justified for all patients undergoing RRP.
• Consideration of preoperative risk factors can help identify patients unlikely to benefit from PLND.
• Alternative staging strategies may be warranted for low-risk prostate cancer patients.