PREDICTIVE VALUE OF THE ANATOMICAL LOCATION OF ULTRASOUND-GUIDED SYSTEMATIC SEXTANT PROSTATE BIOPSIES FOR THE NODAL STATUS OF PATIENTS WITHLOCALIZED PROSTATE-CANCER

Objective: The aim of this study was to determine the predictive value of the anatomical location of positive prostate biopsies for the noda l status of patients with localized prostate cancer. Methods: A total of 130 patients were included in this analysis. Prior to surgery, all patients underwent digital rectal examination (DRE), prostate-specific antigen (PSA) analysis and transrectal ultrasonography with systemati c sextant biopsies. Each biopsy core was analyzed separately. Subseque ntly, all patients underwent pelvic lymphadenectomy and radical retrop ubic prostatectomy. The final pathological stage was correlated with t he number of anatomical location of positive prostate biopsies. Result s: Eighteen patients(13.8%) had positive lymph nodes. Based on clinica l stage, serum PSA and the anatomical location of positive prostate bi opsies, a staging model was developed with particular emphasis on the nodal status. In group I (n = 33; 25.4%), defined by negative basal bi opsies and clinical stage T2 (irrespective of PSA), all patients had n egative lymph nodes. Similarly, all but 1 patient were lymph node nega tive in group II (n = 36; 27.7%), which included cases of positive bas al biopsy, PSA <10 ng/ml clinical T2. Finally, group III (n = 61; 46.9 %), defined by a positive basal biopsy and/or PSA >10 ng/ml and/or cli nical T3 included 17/18 (94.4%) node-positive patients. Conclusion: Ba sed on these data we consider it safe not to perform lymphadenectomy i n group I and group II patients as only 1/69 patients (1.4%) was node positive. Patients meeting the group III criteria, however, should und ergo pelvic lymphadenectomy, as 94.5% of all lymph-node-positive cases were in this group.