title: Lymphatic spread of nodal metastases in high-risk prostate cancer: The ascending pathway from the pelvis to the retroperitoneum.
abstract: BACKGROUND
  The aim of this study was to map the nodal metastases distribution in patients with high-risk prostate cancer (PCa) treated with extended pelvic lymph node dissection (ePLND) and retroperitoneal lymph node dissection (rLND) at the time of radical prostatectomy (RP).
  
  
  METHODS
  This prospective mapping study included 19 patients with high-risk PCa (sharing at least two out of the three following parameters: PSA >20 ng/ml, cT3, biopsy Gleason score ≥8). All patients were treated with RP, ePLND (removal of the obturator, hypogastric, external iliac, presacral, and common iliac lymph nodes) and rLND (removal of para-aortal/para-caval and inter-aorto-caval lymph nodes) by a single surgeon. All patients signed an informed consent highlighting the absence of clinical data supporting the benefit of this surgical approach.
  
  
  RESULTS
  Overall, 18 out of 19 patients (94.7%) had pelvic lymph node invasion. The most commonly affected pelvic nodal landing site was obturator (88.8%), followed by external iliac (83.3%), common iliac (77%), hypogastric (44.4%), and presacral (33.3%). Moreover, 14 (77.8%) patients also had involvement of retroperitoneal lymph nodes. Only patients with positive common iliac lymph nodes having at least five positive lower pelvic lymph nodes (n = 14), also had invariably positive retroperitoneal lymph nodes. No patients with negative common iliac lymph nodes had positive retroperitoneal lymph nodes.
  
  
  CONCLUSIONS
  PCa lymphatic spread ascends from the pelvis up to the retroperitoneum invariably through common iliac lymph nodes. PCa lymphatic spread can be divided in two main levels: pelvic and common iliac plus retroperitoneal lymph nodes.
authors.affiliation: Department of Urology, Vita-Salute University San Raffaele, Milan, Italy. briganti_alberto@yahoo.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.forename: Paolo
authors.initials: P
authors.lastname: Capogrosso
authors.forename: Niccolò
authors.initials: N
authors.lastname: Passoni
authors.forename: Massimo
authors.initials: M
authors.lastname: Freschi
authors.forename: Ettore
authors.initials: E
authors.lastname: di Trapani
authors.forename: Andrea
authors.initials: A
authors.lastname: Gallina
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Manuela
authors.initials: M
authors.lastname: Tutolo
authors.forename: Marco
authors.initials: M
authors.lastname: Bianchi
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.forename: Luigi Filippo
authors.initials: LF
authors.lastname: Da Pozzo
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
mesh_terms: D000368:Aged; D006651:Histocytochemistry; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000473:pathology; D010537:Peritoneum / Q000473:pathology; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery