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 si gnificantly lower incidence of pelvic node involvement, it may be poss ible to identify a segment of patients for whom pelvic lymph node diss ection (PLND) may be omitted. This study was conducted to develop a me thod to select patients for whom PLND could be omitted. Methods. We an alyzed serum prostate-specific antigen (PSA), clinical stage, biopsy G leason score, and final pathologic stage in 481 men with clinically lo calized prostate cancer. These variables were compared to the risk of positive pelvic lymph nodes. Results. Logistic regression analysis det ermined that combining all three variables provided the best determina tion of final pathologic stage. A series of probability curves have be en created to estimate the risk of positive lymph nodes in a given pat ient. Based on the distribution of patients in this study and using th ese probability functions, PLND could be avoided in up to 50% of patie nts 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.