title: Role of anterior prostatic fat pad dissection for extended lymphadenectomy in prostate cancer: a non-randomized study of 100 patients.
abstract: OBJECTIVE
  To determine the incidence and significance of lymph nodes found in anterior prostatic fat pad (APFP) and to evaluate the risk factors for the lymph node presence at the APFP according to preoperative and postoperative characteristics during the robot-assisted radical prostatectomy (RARP).
  
  
  METHODS
  Between January 2011 and December 2014, 100 consecutive patients (47-77) with clinically localized prostate cancer underwent APFP excision during RARP at a single institute. Extended pelvic lymph node dissection was also performed to moderate- and high-risk patients (86 patients). Preoperative and postoperative findings were recorded, and descriptive analyses and multivariable analyses to predict the presence of lymph node within APFP were performed.
  
  
  RESULTS
  Lymph nodes within APFP were detected in nine (9 %) patients. None of the patients had metastatic lymph node in APFP. Preoperatively, mean PSA levels (14.22 vs. 8.6, p = 0.0001), biopsy Gleason score (p = 0.002) and radical prostatectomy pathology Gleason score (p = 0.001) were higher in patients with lymph nodes at the APFP tissue. Pelvic lymph node metastases were detected in seven of 86 (8 %) patients. Of these seven patients, four (57 %) had lymph nodes at the anterior prostatic fatty pad (p = 0.0001).
  
  
  CONCLUSIONS
  APFP dissection must be done regardless of the radical prostatectomy technique chosen. In our opinion, it is not necessary to do pathological examination of the APFP tissue routinely except for the patients with high preoperative PSA values, patients with high prostate biopsy Gleason scores and patients at high risk in order to save time and cost.
authors.affiliation: Department of Urology, Faculty of Medicine, Acibadem Bakirkoy and Maslak Hospitals, Acibadem University, Halit Ziya Usakligil Cad. No: 1, 34140, Bakirkoy, Istanbul, Turkey, burakozkandoc@hotmail.com.
authors.forename: Burak
authors.initials: B
authors.lastname: Ozkan
authors.forename: Burcin
authors.initials: B
authors.lastname: Tunc
authors.forename: Enis Rauf
authors.initials: ER
authors.lastname: Coskuner
authors.forename: Yesim
authors.initials: Y
authors.lastname: Saglican
authors.forename: Veli
authors.initials: V
authors.lastname: Yalçın
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D000368:Aged; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies