Per-operative frozen section examination of pelvic nodes is unnecessary for the majority of clinically localized prostate cancers in the prostate-specific antigen era

Background: The incidence of unsuspected lymph node metastasis seems to be decreasing in the prostate-specific antigen (PSA) era. It remains controver sial as to whether routine pelvic lymph node dissection and per-operative f rozen section examination should be performed. In addition, it is still unc lear whether an aggressive approach to local disease by surgery or irradiat ion confers survival benefits on stage D1 patients. Methods: Eighty-eight consecutive patients with clinically localized prosta te cancer who underwent pelvic lymph node dissection prior to radical prost atectomy during the period between 1985 and 1998 were analyzed. The inciden ce of lymph node metastases after 1992 was compared with that before 1992. Sensitivity and specificity of frozen section examination was assessed. Pro gression-free survival and cause-specific survival curves of node-positive patients who underwent radical prostatectomy were estimated by the Kaplan-M eier method. Results: Six of 17 patients (35.3%) treated before 1992 and five of 71 pati ents (7.0%) treated after 1992 showed unsuspected lymph node metastasis (P = 0.0059). Eight of 11 node-positive patients underwent radical prostatecto my and two have so far demonstrated clinical progression and cancer death w ith a median follow-up period of 63 months. The 5 year progression-free rat e and the cause-specific survival rate for these patients were 71.4 and 85. 7%, respectively. Sensitivity of frozen section examination for micrometast asis and gross-metastasis cases, respectively, was 3/6 (50%) and 4/4 (100%) , while specificity was 85/85 (100%). Conclusions: The incidence of unsuspected lymph node metastases has been si gnificantly decreased in the PSA era. Frozen section examination of pelvic nodes can be omitted and radical prostatectomy is an acceptable choice of t reatment in patients without macroscopically apparent nodal metastases.