OPEN PELVIC LYMPH-NODE DISSECTION FOR PROSTATE-CANCER - A REASSESSMENT

Objectives. To provide a risk-to-benefit analysis of open staging pelv ic lymph node dissection (PLND) for prostate cancer. Methods. The medi cal records of all patients presenting with prostate cancer from July 1989 to April 1994 were reviewed. A total of 245 patients with clinica lly localized disease were selected to undergo radical retropubic pros tatectomy (RRP) preceded by open PLND. Univariate and multivariate ana lyses were performed to evaluate the predictive value of the preoperat ive serum prostate-specific antigen (PSA) concentration, clinical stag e, and Gleason score with regard to final nodal status. The cost and m orbidity associated with PLND in the setting of RRP was also defined. Results. Overall, only 16 patients (6.5%) had lymph node metastases. L ymph node involvement correlated significantly with elevated serum PSA values (P = 0.0001), high Gleason score (P = 0.0022), and advanced cl inical stage (P = 0.0001). Lymph node metastases were particularly unc ommon in patients with nonpalpable tumors (1 of 67 [1.5%]), PSA values less than 10 (2 of 154 [1.3%]), and Gleason score less than 6 (1 of 2 6 [3.8%]). Overall, 179 patients (73.1%) presented with at least one o r more of these favorable characteristics, and only 4 (2.2%) had lymph node involvement. Complications related to the lymphadenectomy oc cur red in 10 patients (4.1%). The cost per metastasis diagnosed in patien ts with low-risk characteristics was approximately $43,600. Conclusion s. An open staging PLND may no longer be justified on a routine basis in patients undergoing radical retropubic prostatectomy.