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Laparoscopic pelvic lymph node dissection in the staging of prostate cancer.
Mt Sinai J Med. 1999 Jan; 66(1):26-30.MS

Abstract

BACKGROUND

Men with localized prostate cancer who present with high risk features may benefit from determination of pelvic lymph node status by a laparoscopic lymph node dissection prior to definitive therapy.

METHODS

One hundred eighty-nine men with a median age of 69 years (range 49-80) with T1-T3 prostate cancer had a laparoscopic pelvic lymph node dissection (LPLND) prior to definitive therapy (radiation or surgery). All patients had a negative bone scan and a computerized tomography of the pelvis prior to the LPLND. In addition, all patients also underwent a seminal vesicle biopsy (SVB) in order to determine the presence of T3c disease. Prostate-specific antigen (PSA) ranged from 1.6-190 ng/mL (median 11 ng/mL) and was > 10 ng/mL in 56.6%, Gleason score was > or = 7 in 46.7%, and 67.8% had clinical stage T2b-T3a.

RESULTS

Of the 189 patients who underwent an LPLND, 22 (11.6%) had a positive dissection. Between 1 and 51 nodes (median 9) were removed per dissection. PSA, clinical stage, Gleason score and SVB results all significantly influenced node findings. Positive nodes were encountered in 26.5% of those with a PSA > 20 ng/mL (p = 0.0002), in 16.4% with stage T2b-T3a (p = 0.003), in 20% with Gleason scores 7-10 (p = 0.0006) and in 38% of men with a positive SVB (p < 0.0001). Logistic regression analysis with PSA, Gleason score, clinical stage and the results of the SVB demonstrated that a positive SVB was the most significant predictor of node positivity. The overall transfusion rate was 1% (2/189) and median hospital stay was one day. The complication rate for the LPLND was 9% (17/189).

CONCLUSION

The LPLND is an effective and efficient means of detecting positive pelvic lymph nodes in patients with localized prostate cancer. It should be considered a necessary diagnostic modality in all appropriate patients who may be candidates for curative therapy.

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Authors+Show Affiliations

Stone NN
Department of Urology, Mount Sinai School of Medicine, New York, NY, USA.
Stock RG
No affiliation info available

MeSH

AgedAged, 80 and overBiopsyChi-Square DistributionHumansLaparoscopyLogistic ModelsLymph Node ExcisionLymphatic MetastasisMaleMiddle AgedNeoplasm StagingProstate-Specific AntigenProstatic Neoplasms

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9989102

Citation

Stone, N N., and R G. Stock. "Laparoscopic Pelvic Lymph Node Dissection in the Staging of Prostate Cancer." The Mount Sinai Journal of Medicine, New York, vol. 66, no. 1, 1999, pp. 26-30.
Stone NN, Stock RG. Laparoscopic pelvic lymph node dissection in the staging of prostate cancer. Mt Sinai J Med. 1999;66(1):26-30.
Stone, N. N., & Stock, R. G. (1999). Laparoscopic pelvic lymph node dissection in the staging of prostate cancer. The Mount Sinai Journal of Medicine, New York, 66(1), 26-30.
Stone NN, Stock RG. Laparoscopic Pelvic Lymph Node Dissection in the Staging of Prostate Cancer. Mt Sinai J Med. 1999;66(1):26-30. PubMed PMID: 9989102.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic pelvic lymph node dissection in the staging of prostate cancer. AU - Stone,N N, AU - Stock,R G, PY - 1999/2/16/pubmed PY - 1999/2/16/medline PY - 1999/2/16/entrez SP - 26 EP - 30 JF - The Mount Sinai journal of medicine, New York JO - Mt Sinai J Med VL - 66 IS - 1 N2 - BACKGROUND: Men with localized prostate cancer who present with high risk features may benefit from determination of pelvic lymph node status by a laparoscopic lymph node dissection prior to definitive therapy. METHODS: One hundred eighty-nine men with a median age of 69 years (range 49-80) with T1-T3 prostate cancer had a laparoscopic pelvic lymph node dissection (LPLND) prior to definitive therapy (radiation or surgery). All patients had a negative bone scan and a computerized tomography of the pelvis prior to the LPLND. In addition, all patients also underwent a seminal vesicle biopsy (SVB) in order to determine the presence of T3c disease. Prostate-specific antigen (PSA) ranged from 1.6-190 ng/mL (median 11 ng/mL) and was > 10 ng/mL in 56.6%, Gleason score was > or = 7 in 46.7%, and 67.8% had clinical stage T2b-T3a. RESULTS: Of the 189 patients who underwent an LPLND, 22 (11.6%) had a positive dissection. Between 1 and 51 nodes (median 9) were removed per dissection. PSA, clinical stage, Gleason score and SVB results all significantly influenced node findings. Positive nodes were encountered in 26.5% of those with a PSA > 20 ng/mL (p = 0.0002), in 16.4% with stage T2b-T3a (p = 0.003), in 20% with Gleason scores 7-10 (p = 0.0006) and in 38% of men with a positive SVB (p < 0.0001). Logistic regression analysis with PSA, Gleason score, clinical stage and the results of the SVB demonstrated that a positive SVB was the most significant predictor of node positivity. The overall transfusion rate was 1% (2/189) and median hospital stay was one day. The complication rate for the LPLND was 9% (17/189). CONCLUSION: The LPLND is an effective and efficient means of detecting positive pelvic lymph nodes in patients with localized prostate cancer. It should be considered a necessary diagnostic modality in all appropriate patients who may be candidates for curative therapy. SN - 0027-2507 UR - https://www.unboundmedicine.com/medline/citation/9989102/Laparoscopic_pelvic_lymph_node_dissection_in_the_staging_of_prostate_cancer_ L2 - http://www.diseaseinfosearch.org/result/9175 DB - PRIME DP - Unbound Medicine ER -