[Is there a place for radical prostatectomy without lymphadenectomy?]

Herein we present the procedure we have followed to determine N+ low-risk factors which allow us to identify those patients with prostate cancer in whom radical perineal prostatectomy (RPP) can be performed without a previous staging lymphadenectomy, thereby maintaining the oncological principles but with less morbidity.

In a series of 88 patients who underwent RPP, we identified an N+ low-risk factor group; i.e., patients with clinically localized tumor of the prostate gland, a Gleason score of < or = 7 and PSA < or = 10 ng/ml. The foregoing criteria were based on the findings reported by Stamey and the status of the lymph nodes of our own series of radical prostatectomies.

In 71 of the 88 patients with a follow up of more than one year, RPP was performed after laparoscopic pelvic lymphadenectomy. Of these 71 patients, 17 (19.3%) presented the above-mentioned low-risk characteristics and were all pN-. Since then, the subsequent patients who met this low-risk criteria (n = 17; 19.3% of the total) were submitted to RPP alone without previous staging lymphadenectomy. The rate of positive margins in this group was 17.6%, all cases maintaining PSA within feminization levels after a mean follow-up of 21.7 months. Considering the overall series, 38.6% of the patients could have avoided lymphadenectomy according to our criteria.

We have found RPP without previous staging lymphadenectomy to be a valid therapeutic option for patients with clinically localized prostate cancer, preoperative PSA < or = 10 ng/ml and a Gleason score of < or = 7. According to our data, this group accounts for approximately 40% of the patients in whom radical prostatectomy had been recommended.