title: Bilateral lymph node micrometastases and seminal vesicle invasion associated with same clinical predictors in localized prostate cancer.
abstract: OBJECTIVE
  To determine clinical factors associated with multiple bilateral lymph node micrometastases and seminal vesicle invasion (pT3b) in organ-confined prostate cancer (PCa).
  
  
  METHODS
  The study excluded patients under androgen deprivation, with lymph node involvement (cN1 status), and having undergone unilateral pelvic lymph node dissection (PLND) during radical prostatectomy (RP). Lymph node micrometastases were classified as unilateral (pN1m) and bilateral (pN1b). Analysis considered multivariate multinomial logistic regression models.
  
  
  RESULTS
  Between January 2013 and March 2015, 140 patients underwent PLND during RP. Lymph node micrometastases were detected in 28 cases (20%) including pN1m in 19 (13.6%) and pN1b in 9 (6.4%). Independent clinical predictors of pN1b included prostate-specific antigen (PSA, µg/L) >12.5 (odds ratio [OR] = 43.0), proportion of positive biopsy cores (PBC) >0.57 (OR = 6.7), and biopsy Gleason grade (bGG) >3 (OR = 7.5). Independent pT3b predictors included PSA>12.5 (OR = 3.8), PBC>0.57 (OR = 4.1), and bGG>3 (OR = 3.8).
  
  
  CONCLUSIONS
  In cN0 patients with localized PCa undergoing PLND, a nonnegligible rate of multiple lymph node micrometastases was detected (32.2%). In the natural history of PCa, there is a close association between pT3b and pN1b disease. Prostate cancer patients who are at high risk of extraglandular extension need selective pelvic staging by multiparametric magnetic resonance imaging to assess seminal vesicle invasion. Operated patients with pT3b and pNx status need close PSA monitoring because of the high probability of occult multiple bilateral lymph node micrometastases.
authors.affiliation: Urology Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors.forename: Antonio B
authors.initials: AB
authors.lastname: Porcaro
authors.affiliation: Urology Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors.forename: Nicolò
authors.initials: N
authors.lastname: de Luyk
authors.affiliation: Urology Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Corsi
authors.affiliation: Urology Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Sebben
authors.affiliation: Urology Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Tafuri
authors.affiliation: Urology Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Tamanini
authors.affiliation: Urology Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors.forename: Tania
authors.initials: T
authors.lastname: Processali
authors.affiliation: Urology Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Cerruto
authors.affiliation: Urology Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Migliorini
authors.affiliation: Department of Pathology, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Brunelli
authors.affiliation: Urology Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Siracusano
authors.affiliation: Urology Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy.
authors.forename: Walter
authors.initials: W
authors.lastname: Artibani
mesh_terms: D000368:Aged; D062005:Biopsy, Large-Core Needle; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness / Q000473:pathology; D061206:Neoplasm Micrometastasis / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D012669:Seminal Vesicles / Q000473:pathology
chemical_list: D017430:Prostate-Specific Antigen