Pelvic lymphadenectomy can be omitted in selected patients with carcinoma of the prostate: development of a system of patient selection

Objectives. The prevalence of pelvic lymph node metastases in men with clinically localized prostate cancer has decreased dramatically over the past decade, possibly due to efforts at early detection. With a significantly lower incidence of pelvic node involvement, it may be possible to identify a s...

Full description

Saved in:
Bibliographic Details
Published in:Urology (Ridgewood, N.J.) N.J.), 1995-02, Vol.45 (2), p.270-274
Main Authors: Bishoff, Jay T., Reyes, Antonio, Thompson, Ian M., Harris, Michael J., St Clair, Stephen R., Gomella, Leonard, Butzin, Clifford A.
Format: Article
Language:English
Subjects:
Biological and medical sciences
Humans
Logistic Models
Lymph Node Excision
Lymphatic Metastasis
Male
Medical sciences
Neoplasm Staging
Nephrology. Urinary tract diseases
Patient Selection
Prostate-Specific Antigen
Prostatic Neoplasms - blood
Prostatic Neoplasms - pathology
Prostatic Neoplasms - surgery
Risk Factors
Tumors of the urinary system
Urinary tract. Prostate gland
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Objectives. The prevalence of pelvic lymph node metastases in men with clinically localized prostate cancer has decreased dramatically over the past decade, possibly due to efforts at early detection. With a significantly lower incidence of pelvic node involvement, it may be possible to identify a segment of patients for whom pelvic lymph node dissection (PLND) may be omitted. This study was conducted to develop a method to select patients for whom PLND could be omitted. Methods. We analyzed serum prostate-specific antigen (PSA), clinical stage, biopsy Gleason score, and final pathologic stage in 481 men with clinically localized prostate cancer. These variables were compared to the risk of positive pelvic lymph nodes. Results. Logistic regression analysis determined that combining all three variables provided the best determination of final pathologic stage. A series of probability curves have been created to estimate the risk of positive lymph nodes in a given patient. Based on the distribution of patients in this study and using these probability functions, PLND could be avoided in up to 50% of patients with localized prostate cancer diagnosed by contemporary methods. Conclusions. In properly selected patients, pelvic lymphadenectomy can be omitted in the staging and treatment of localized prostate cancer.
ISSN:0090-4295
1527-9995
DOI:10.1016/0090-4295(95)80017-4