Laparoscopic pelvic lymph-node dissection in prostate cancer before external beam radiotherapy: Risk factors of nodal involvement and relapse following intended curative treatment.
OBJECTIVE
To report experience with laparoscopic pelvic lymph-node dissection (LPLND) in patients with prostate cancer before radiotherapy. Selection of risk factors for nodal involvement (N1) and recurrence following radiotherapy was made.


METHODS
From November 1999 to June 2007, 177 patients with prostate cancer underwent LPLND at this department. The lymphadenectomy was limited to the obturator fossa bilaterally. Patients without nodal involvement were offered external beam radiotherapy with adjuvant hormone treatment.


RESULTS
Complications occurred in 17 patients (9%). The majority of these were minor and were managed by conservative methods. Twenty-six patients (15%) were diagnosed with N1. High Gleason score and a high percentage of positive needle core biopsies were both risk factors of N1 as well as recurrent disease following radiotherapy (p<0.01 and 0.01, respectively). Clinically, T3 disease was associated with a risk of recurrence but not N1. High prostate-specific antigen (PSA) nadir was also a significant predictor of recurrence. Neither pretreatment PSA nor prostate volume was associated with N1 or recurrence.


CONCLUSIONS
LPLND is a safe, well-established staging modality in clinically localized prostate cancer before radiotherapy. Risk factors upon diagnosis may be useful in the estimation of N1 and risk of recurrence.
Bjerggaard Jensen
Jørgen
J
Department of Urology, Regionshospitalet Holstebro, Denmark. jb@doktor.dk
Johansen
Jørgen K
JK
Graversen
Peder H
PH