title: Detailed analysis of patients with metastasis to the prostatic anterior fat pad lymph nodes: a multi-institutional study.
abstract: OBJECTIVE
  Lymph nodes in the prostatic anterior fat pad rarely harbor metastatic disease. Therefore, the characteristics of patients with prostatic anterior fat pad lymph node metastasis are not well described in the literature. We identified the perioperative characteristics and assessed the clinical outcomes of patients with prostatic anterior fat pad lymph node metastasis.
  
  
  METHODS
  At 8 tertiary care centers a total of 4,261 patients underwent complete removal and pathological analysis of the prostatic anterior fat pad. We describe preoperative and pathological characteristics, and clinical management and outcomes in patients with metastatic disease to the prostatic anterior fat pad.
  
  
  RESULTS
  Metastatic disease to the prostatic anterior fat pad lymph nodes was detected in 40 patients (0.94%), of whom 37 (92.5%) had intermediate or high risk features preoperatively. Most patients with prostatic anterior fat pad metastases underwent concomitant pelvic lymph node dissection, and adjuvant therapy with radiation, androgen ablation and/or chemotherapy. A total of 27 patients (67.5%) with prostatic anterior fat pad metastatic disease were up-staged as a result of prostatic anterior fat pad pathological analysis, of whom 14 (51.8%) remained free of biochemical recurrence with observation and/or definitive adjuvant/salvage therapy.
  
  
  CONCLUSIONS
  Most patients with prostatic anterior fat pad metastatic disease had intermediate to high risk features preoperatively. In some patients with such lymph node metastasis removing these lymph nodes resulted in prolonged biochemical recurrence-free survival. Therefore, we recommend that the prostatic anterior fat pad be removed in all patients undergoing radical prostatectomy. However, pathological analysis of the prostatic anterior fat pad may be limited to patients with intermediate to high risk oncological features preoperatively.
authors.affiliation: Section of Urologic Oncology and Dean and Betty Gallo Prostate Cancer Center, Cancer Institute of New Jersey, New Brunswick, New Jersey 08903, USA. kimiy@umdnj.edu
authors.forename: Isaac Yi
authors.initials: IY
authors.lastname: Kim
authors.forename: Parth K
authors.initials: PK
authors.lastname: Modi
authors.forename: Evita
authors.initials: E
authors.lastname: Sadimin
authors.forename: Yun-Sok
authors.initials: YS
authors.lastname: Ha
authors.forename: Jeong Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Douglas
authors.initials: D
authors.lastname: Skarecky
authors.forename: Doh Yoon
authors.initials: DY
authors.lastname: Cha
authors.forename: Chris O
authors.initials: CO
authors.lastname: Wambi
authors.forename: Yen-Chuan
authors.initials: YC
authors.lastname: Ou
authors.forename: Bertram
authors.initials: B
authors.lastname: Yuh
authors.forename: Sejun
authors.initials: S
authors.lastname: Park
authors.forename: Elton
authors.initials: E
authors.lastname: Llukani
authors.forename: David M
authors.initials: DM
authors.lastname: Albala
authors.forename: Timothy
authors.initials: T
authors.lastname: Wilson
authors.forename: Thomas
authors.initials: T
authors.lastname: Ahlering
authors.forename: Ketan
authors.initials: K
authors.lastname: Badani
authors.forename: Hanjong
authors.initials: H
authors.lastname: Ahn
authors.forename: David I
authors.initials: DI
authors.lastname: Lee
authors.forename: Michael
authors.initials: M
authors.lastname: May
authors.forename: Wun-Jae
authors.initials: WJ
authors.lastname: Kim
authors.forename: Dong Hyeon
authors.initials: DH
authors.lastname: Lee
mesh_terms: D000273:Adipose Tissue / Q000473:pathology* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000628:therapy; D018714:Radiotherapy, Adjuvant; D016879:Salvage Therapy
keywords: AA; BCR; CINJ; Cancer Institute of New Jersey; PAFP; PCa; PLND; PSA; RARP; RP; XRT; androgen ablation; biochemical recurrence; ePLND; extended PLND; external beam radiation therapy; lymph nodes; neoplasm metastasis; pelvic lymph node dissection; prostate; prostate cancer; prostate specific antigen; prostatic anterior fat pad; prostatic neoplasms; radical prostatectomy; risk; robot-assisted radical prostatectomy