Open pelvic lymph node dissection for prostate cancer: a reassessment.
OBJECTIVE
To provide a risk-to-benefit analysis of open staging pelvic lymph node dissection (PLND) for prostate cancer.


METHODS
The medical records of all patients presenting with prostate cancer from July 1989 to April 1994 were reviewed. A total of 245 patients with clinically localized disease were selected to undergo radical retropubic prostatectomy (RRP) preceded by open PLND. Univariate and multivariate analyses were performed to evaluate the predictive value of the preoperative serum prostate-specific antigen (PSA) concentration, clinical stage, and Gleason score with regard to final nodal status. The cost and morbidity associated with PLND in the setting of RRP was also defined.


RESULTS
Overall, only 16 patients (6.5%) had lymph node metastases. Lymph node involvement correlated significantly with elevated serum PSA values (P = 0.0001), high Gleason score (P = 0.0022), and advanced clinical stage (P = 0.0001). Lymph node metastases were particularly uncommon in patients with nonpalpable tumors (1 of 67 [1.5%]), PSA values less than 10 (2 of 154 [1.3%]), and Gleason score less than 6 (1 of 26 [3.8%]). Overall, 179 patients (73.1%) presented with at least one or more of these favorable characteristics, and only 4 (2.2%) had lymph node involvement. Complications related to the lymphadenectomy occurred in 10 patients (4.1%). The cost per metastasis diagnosed in patients with low-risk characteristics was approximatley $43,600.


CONCLUSIONS
An open staging PLND may no longer be justified on a routine basis in patients undergoing radical retropubic prostatectomy.
Campbell
S C
SC
Department of Urology, Cleveland Clinic Foundation, Ohio 44195, USA.
Klein
E A
EA
Levin
H S
HS
Piedmonte
M R
MR
D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery*; D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects / Q000191:economics; D008207:Lymphatic Metastasis; D008210:Lymphocele / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009776:Obturator Nerve / Q000293:injuries; D016017:Odds Ratio; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012044:Regression Analysis; D018570:Risk Assessment; D013927:Thrombosis / Q000209:etiology
D017430:Prostate-Specific Antigen