title: Pelvic lymphadenectomy can be omitted in selected patients with carcinoma of the prostate: development of a system of patient selection.
abstract: OBJECTIVE
  The prevalence of pelvic lymph node metastases in men with clinically localized prostate cancer has decreased dramatically over the past decade, possibly due to efforts at early detection. With a significantly lower incidence of pelvic node involvement, it may be possible to identify a segment of patients for whom pelvic lymph node dissection (PLND) may be omitted. This study was conducted to develop a method to select patients for whom PLND could be omitted.
  
  
  METHODS
  We analyzed serum prostate-specific antigen (PSA), clinical stage, biopsy Gleason score, and final pathologic stage in 481 men with clinically localized prostate cancer. These variables were compared to the risk of positive pelvic lymph nodes.
  
  
  RESULTS
  Logistic regression analysis determined that combining all three variables provided the best determination of final pathologic stage. A series of probability curves have been created to estimate the risk of positive lymph nodes in a given patient. Based on the distribution of patients in this study and using these probability functions, PLND could be avoided in up to 50% of patients with localized prostate cancer diagnosed by contemporary methods.
  
  
  CONCLUSIONS
  In properly selected patients, pelvic lymphadenectomy can be omitted in the staging and treatment of localized prostate cancer.
authors.affiliation: Urology Services, Wilford Hall USAF Medical Center, San Antonio, Texas.
authors.forename: J T
authors.initials: JT
authors.lastname: Bishoff
authors.forename: A
authors.initials: A
authors.lastname: Reyes
authors.forename: I M
authors.initials: IM
authors.lastname: Thompson
authors.forename: M J
authors.initials: MJ
authors.lastname: Harris
authors.forename: S R
authors.initials: SR
authors.lastname: St Clair
authors.forename: L
authors.initials: L
authors.lastname: Gomella
authors.forename: C A
authors.initials: CA
authors.lastname: Butzin
mesh_terms: D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D018579:Patient Selection; D017430:Prostate-Specific Antigen; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors
chemical_list: D017430:Prostate-Specific Antigen