The staging pelvic lymphadenectomy: implications as an adjunctive procedure for clinically localized prostate cancer.
OBJECTIVE
To evaluate the utility of staging pelvic lymphadenectomy and to identify factors associated with nodal metastases in which a node dissection would be of clinical benefit.


METHODS
A retrospective analysis (1989-1993) was performed on 303 consecutive patients who underwent staging bilateral modified pelvic lymph node dissection for clinically localized prostate cancer. Multivariate logistic regression analysis was used to evaluate age, race, clinical stage, prostate-specific antigen (PSA) level and Gleason score for predicting nodal metastases.


RESULTS
Twenty-eight patients had nodal metastases, giving an overall prevalence of 9.2%. PSA and Gleason score (both P < 0.001) were significantly predictive of nodal involvement when combined or as independent variables. Relative to PSA and Gleason score, the patients' age, race and clinical stage were less relevant. Sensitivity analysis determined that combining a PSA of > or = 20 ng/mL (normal 0-4) and a Gleason score of > or = 8 gave a negative predictive value of 92% with a specificity of 99%, a positive predictive value of 67% and an overall accuracy of 91% for predicting nodal metastases.


CONCLUSIONS
From this data, lymph node metastases are unlikely in patients with clinically localized prostate cancer who have a PSA of < 20 ng/mL and a Gleason score < 8, and that a pelvic lymph node dissection as an adjunctive procedure should be avoided in such individuals.
Alagiri
M
M
Department of Urology, Temple University School of Medicine, Pennsylvania, USA.
Colton
M D
MD
Seidmon
E J
EJ
Greenberg
R E
RE
Hanno
P M
PM
D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000379:methods*; D010388:Pelvis; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D017430:Prostate-Specific Antigen