RISK OF NODAL METASTASES AT LAPAROSCOPIC PELVIC LYMPHADENECTOMY USINGPSA, GLEASON SCORE, AND CLINICAL STAGE IN MEN WITH LOCALIZED PROSTATE-CANCER

Laparoscopic pelvic lymph node dissection (LPLND) is a low-morbidity p rocedure used to stage prostate cancer accurately prior to definitive local therapy, To better select patients for LPLND, we reviewed the cl inical features of 120 patients with clinically localized prostate can cer who underwent LPLND to define significant risk factors for nodal m etastases, The age ranged from 43 to 79 years (mean 68), Serum prostat e specific antigen (PSA) concentration ranged from 1.3 to 329 ng/mL, G leason score ranged from 2 to 9, and clinical stage ranged from T1b to T3c, Nodal metastases were discovered in 15 patients (13%), Among men with a Gleason score greater than or equal to 7, 21% had nodal metast ases (P = 0.004), A serum PSA >20 ng/mL and clinical stage T1b, T2b, o r greater also were statistically significant predictors of lymph node metastases (20% and 19%, respectively), In multivariate analysis, Gle ason score: significantly predicted nodal metastases when controlling for all other clinical measures, Therefore, LPLND is indicated for arm y patient with a Gleason score greater than or equal to 7, PSA >20 ng/ mL, and advanced clinical T stage, independently or in combination.