ARE PELVIC COMPUTED-TOMOGRAPHY, BONE-SCAN AND PELVIC LYMPHADENECTOMY NECESSARY IN THE STAGING OF PROSTATIC-CANCER

Objective To investigate the effectiveness and economy of pelvic compu ted tomography (CT), bone scan and pelvic lymphadenectomy as staging m odalities in patients undergoing radical prostatectomy. The use of pro state specific antigen (PSA) and Gleason's score as adjuncts to predic t extracapsular disease were also evaluated and their economic implica tions examined. Patients and methods Between January 1990 and June 199 3, 861 men were newly diagnosed with prostate cancer, of whom 409 unde rwent surgery. All patients underwent pelvic CT scans and PSA analysis , Patients undergoing surgery had pre-operative bone scans and Gleason 's scoring of their pathological tissue. Results Only 13 (1.5%) of 861 men had positive pelvic CT scans. Of the 409 patients who underwent s urgery, all had negative pelvic CT and bone scans, and all underwent a modified pelvic lymphadenectomy; 192 (47%) had extracapsular disease. Only 15 (3.7%) patients who underwent surgery were found to have posi tive nodes. Conclusions The use of pelvic CT and bone scans for clinic al staging in patients with a PSA level of less than or equal to 20 ng /mL should not be advocated because they have a very low yield and are not cost effective. We question the role of a modified pelvic lymphad enectomy for staging purposes, either by an open or laparoscopic proce dure, because the yield of positive diagnoses is very low.