EVALUATION OF STAGING LYMPHADENECTOMY IN PROSTATE-CANCER

Objectives. To prospectively evaluate a clinical algorithm that predic ts nodal status in patients with prostate cancer and to assess the imp act on the outcome. Methods. Between September 1988 and December 1994, 192 patients with organ-confined prostate cancer and considered surgi cal candidates for radical perineal prostatectomy (RPP) were stratifie d using the algorithm: prostate-specific antigen (PSA) 20 ng/mL or les s, Gleason score 7 or fewer, and clinical Stage T2a or lower. Patients failing any of these criteria were placed in the high-risk group and underwent a pelvic lymphadenectomy. Patients who satisfied all the cri teria were placed in the low-risk group and underwent RPP without eval uation of the pelvic lymph nodes. Another contemporaneous cohort of pa tients (n = 65) underwent pelvic lymphadenectomy and radical retropubi c prostatectomy [RRP] without use of the algorithm and were used as a control group. Patients were monitored for at least 24 months. Results . In the RPP group, 177 patients were considered low risk according to the algorithm and were not offered staging lymphadenectomy before sur gery, whereas 15 patients were categorized as high risk for metastasis and underwent staging lymphadenectomy. In the RRP and lymphadenectomy group, 41 patients were considered at low risk and 24 at high risk of disease spread according to the algorithm. In the RPP group, low-risk patients (no lymphadenectomy) had a PSA recurrence rate (27%) similar to that of low-risk patients in the RRP group with negative lymph nod es (29%), P = 0.8. Similarly, high-risk patients with negative lymph n odes in both groups had a similar recurrence rate (53% for RPP and 50% for RRP). Univariate logistic regression analysis showed that PSA was the most significant predictor for disease recurrence (P = 0.0004) fo llowed by preoperative Gleason scores (P = 0.02) and clinical stages ( P = 0.03). Multivariate stepwise analysis demonstrated that Gleason sc ore and clinical stage did not add to the prediction of recurrence ove r PSA alone. Conclusions. Staging lymphadenectomy can be omitted in lo w-risk patients without: deleterious effects on the outcome as measure d by PSA recurrence. UROLOGY 52: 663-667, 1998. (C) 1998, Elsevier Sci ence Inc. All rights reserved.