Intraoperative lymph node staging of prostate cancer: the case against.
BACKGROUND
Intraoperative frozen section analysis of obturator nodes is an accepted screening procedure, excluding from prostatectomy that group of node-positive patients who are presumed to almost always have disseminated cancer. The overall efficacy of this procedure depends not only on the near inevitability of cancer progression in these patients, but also the procedure morbidity (previously estimated at 8.4%), the additional costs (currently estimated at A$1200) and the infrequency of positive nodes. We evaluate the efficacy of lymph node staging for prostate cancer.


METHODS
We have evaluated the efficacy of intraoperative screening by node dissection in 123 prostatectomy cases. These cases were prescreened from a series of 261 radical prostatectomies by evaluating preoperative serum PSA and Gleason grade.


RESULTS
Three patients were identified with nodal disease, representing a detection rate of 2.4%. The present study confirms that current trends in prostate cancer identification and selection of individuals for radical surgery very rarely identify node-positive disease even after preselection with accepted 'high-risk' markers.


CONCLUSIONS
Considering the attendant cost and morbidity, there appears to be no justification for lymph node dissection as a routine preliminary to prostatectomy.
Garrett
Kerry L
KL
Tissugen Pty Ltd, Uropath Pty Ltd, Perth, Western Australia, Australia.
McNeal
John E
JE
Cohen
Ronald J
RJ
D000328:Adult; D000368:Aged; D006801:Humans; D007430:Intraoperative Care / Q000191:economics*; D008197:Lymph Node Excision / Q000191:economics*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000191:economics*; D017063:Outcome Assessment, Health Care; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000191:economics*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D015203:Reproducibility of Results
D017430:Prostate-Specific Antigen