title: Laparoscopic pelvic lymph node dissection combined with real-time interactive transrectal ultrasound guided transperineal radioactive seed implantation of the prostate.
abstract: Laparoscopic pelvic lymph node dissection with real-time interactive transrectal ultrasound guided transperineal radioactive seed implantation is a new method of treatment for localized carcinoma of the prostate. A total of 58 patients with clinically confined prostate cancer and negative seminal vesicle biopsies underwent staging laparoscopic pelvic lymph node dissection immediately followed by prostate implantation: 50 had 125iodine and 8 had 103palladium implants. Mean operating time was 226 minutes (range 120 to 475), mean blood loss was 57 cc (range 5 to 400) and average hospital stay was 2.2 days (range 0.5 to 8). At a mean followup of 12 months (range 6 to 24), complications included proctitis in 1.7% of the cases, dysuria in 24%, nocturia in 21% and outlet obstruction in 17%. Erectile function remained unchanged. Prostate volume decreased to 58.9% of the pretreatment value by 12 months and to 44.3% by 24 months. Mean prostate specific antigen level was 18.4 +/- 26.3 ng./ml. before treatment, 3.4 +/- 3.9 ng./ml. at 6 months, 2.3 +/- 2.3 ng./ml. at 12 months and 4.9 +/- 6.0 ng./ml. at 24 months (1.2 +/- 1.0 ng./ml. for patients with no evidence of disease). Of the patients 15.8% had local failure at 18 to 24 months as determined by positive transrectal ultrasound guided biopsy. Five of 58 patients (8.6%) had persistently elevated prostate specific antigen levels, only 1 of whom had a positive biopsy. Laparoscopic pelvic lymph node dissection with transrectal ultrasound guided implantation is a safe and promising mode of therapy for patients with localized prostate cancer.
authors.affiliation: Department of Urology, Mount Sinai Medical Center, New York, New York, USA.
authors.forename: N N
authors.initials: NN
authors.lastname: Stone
authors.forename: S A
authors.initials: SA
authors.lastname: Ramin
authors.forename: M F
authors.initials: MF
authors.lastname: Wesson
authors.forename: R
authors.initials: R
authors.lastname: Stock
authors.forename: P
authors.initials: P
authors.lastname: Unger
authors.forename: G
authors.initials: G
authors.lastname: Klein
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D010165:Palladium / Q000627:therapeutic use*; D010388:Pelvis; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D011868:Radioisotopes / Q000627:therapeutic use*; D013997:Time Factors; D017211:Treatment Failure; D014463:Ultrasonography
chemical_list: D007457:Iodine Radioisotopes; D011868:Radioisotopes; D010165:Palladium; D017430:Prostate-Specific Antigen