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Is pelvic lymph node dissection required at radical prostatectomy for low‐risk prostate cancer?
Author(s) -
Mitsuzuka Koji,
Koie Takuya,
Narita Shintaro,
Kaiho Yasuhiro,
Yoneyama Takahiro,
Kawamura Sadafumi,
Tochigi Tatsuo,
Ohyama Chikara,
Habuchi Tomonori,
Arai Yoichi
Publication year - 2013
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12112
Subject(s) - medicine , lymph node , nomogram , prostatectomy , dissection (medical) , prostate cancer , lymph , urology , laparoscopic radical prostatectomy , pelvic cavity , surgery , radiology , cancer , pathology
Objectives To determine the necessity of pelvic lymph node dissection for low‐risk prostate cancer, we analyzed the incidence of lymph node invasion and the therapeutic value of pelvic lymph node dissection in low‐risk prostate cancer patients. Methods Medical records for 1268 patients undergoing open radical prostatectomy between J anuary 2000 and D ecember 2009 who had not undergone neoadjuvant therapy were retrospectively reviewed. Patients with low‐risk disease ( n = 222; prostate‐specific antigen <10 ng/mL, biopsy G leason score ≤6, clinical T 1c or T 2a) were classified according to whether they underwent pelvic lymph node dissection (pelvic lymph node dissection group, n = 147) or did not (no pelvic lymph node dissection group, n = 75). Pelvic lymph node dissection was carried out in a limited style, which included the external iliac vein and the obturator fossa. The incidence of lymph node invasion was determined and referred to the preoperative nomogram developed for J apanese patients ( J apanese nomogram), P artin and K attan nomograms. The 5‐year biochemical recurrence‐free survivals in both groups were analyzed. Results Lymph node invasion in low‐, intermediate‐ and high‐risk disease was 0.7% (1/147), 1.2% (7/595) and 6.1% (23/374). The 5‐year biochemical recurrence‐free survival rates for patients with low‐risk disease were 87.6% in the pelvic lymph node dissection group and 87.1% in the no pelvic lymph node dissection group ( P = 0.65, log–rank). No patients in the pelvic lymph node dissection group exceeded 2% of lymph node invasion risk with J apanese and P artin nomograms. With the K attan nomogram, 22.4% (33/147) of the pelvic lymph node dissection group exceeded 2% of lymph node invasion risk, and one patient had documented lymph node invasion, but none exceeded 2.5%. Conclusions Pelvic lymph node dissection can be spared at radical prostatectomy for low‐risk disease, as its diagnostic and therapeutic value is poor.