[Significance and Importance of Pelvic Lymphadenectomy in Low-Risk Prostate Cancer Patients].
The most frequent carcinoma in male patients is prostate cancer. D'Amico and colleagues (1998) set up a classification to assess the aggressiveness of prostate cancer growth and the risk of metastatic spread, taking into account the following parameters: PSA, Gleason Score (GS), and tumour spread (T). The combination of these parameters results in a classification of low-, intermediate- and high-risk patients.In the context of a larger heuristic study entitled "Low-Risk Prostate Cancer Patients: Significance And Importance Of Pelvic Lymphadenectomy in Localized Prostate Carcinomas", we observed the correlation of the parameters PSA, GS and T stage with the occurrence of lymph node metastases in low-risk-patients who underwent lymphadenectomy during radical prostatectomy.



Due to a lack of evidence - none of the confirmed LR (low-risk=LR) patients was diagnosed with metastases - we set up a subclassification for LR patients for the following corridor transition zone between low-risk and high-risk patients (based on the D'Amico classification):PSA≤10 ng/ml and GS≤7a (c: 7a) and clinical stage T1a-T2c (c: T2b, T2c): The population consists of 288 prostate cancer patients (60 low-risk (LR) patients, 228 corridor (c) patients). We analysed the number and frequency of removed lymph nodes and lymph node metastases. Moreover, we analysed the population with a view to a postoperative GS upgrade. The results are based on heuristic methods.



The situation regarding the data in the transition zone, i. e. in the corridor area, and in the verified low-risk range is very complicated:In total, 3 743 lymph nodes were removed in 288 patients (mean: 13 lymph nodes). Of these only 7 lymph nodes in 5 patients from the corridor group were metastatic. The overall number of removed lymph nodes in these 5 patients lies within a small interval [23,32]; 26 lymph nodes were removed on average. A postoperative Gleason Score upgrade was found in 20.14% of the whole patient population.



A postoperative Gleason Score upgrade in every fifth patient shows a highly relevant preoperative undergrading in these patients, which may lead to inadequate treatment. An opening of the D'Amico classification to include a corridor category of patients could be an opportunity to minimise preoperative undergrading. In this context, pelvic lymphadenectomy must be considered, at least for corridor patients.
Klinik für Anästhesiologie und Intensivmedizin Bonn.
I
I
Janßen
Klinik für Urologie und Kinderurologie Kiel.
C M
CM
Naumann
Klinik für Urologie und Kinderurologie Kiel.
M
M
Hamann
Klinik für Urologie und Kinderurologie Kiel.
S
S
Knüpfer
Klinik für Urologie und Kinderurologie Kiel.
K P
KP
Jünemann
Klinik für Urologie und Kinderurologie Kiel.
D K
DK
Osmonov
D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000145:classification / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012306:Risk; D015996:Survival Rate