The staging pelvic lymphadenectomy: Implications as an adjunct!ve procedure for clinically localized prostate cancer

Objectives To evaluate the utility of staging pelvic lymphadenectomy and to identify factors associated with nodal métastases in which a node dissection would be of clinical benefit. Patients and methods A retrospective analysis (1989-1993) was performed on 303 consecutive patients who underwent staging bilateral modified pelvic lymph node dissection for clinically localized prostate cancer. Multivariate logistic regression analysis was used to evaluate age. race, clinical stage, prostate-specific antigen (PSA) level and Gleason score for predicting nodal métastases. Results Twenty-eight patients had nodal métastases, giving an overall prevalence of 9.2%. PSA and Gleason score (both P < 0.001) were significantly predictive of nodal involvement when combined or as independent variables. Relative to PSA and Gleason score, thé patients' age, race and clinical stage were less relevant. Sensitivity analysis determined that combining a PSA of 5=20 ng/mL (normal 0-4) and a Gleason score of 5=8 gave a negative predictive value of 92% with a specificity of 99%, a positive predictive value of 67% and an overall accuracy of 91% for predicting nodal métastases. Conclusion From this data, lymph node métastases are unlikely in patients with clinically localized prostate cancer who have a PSA of <20 ng/mL and a Gleason score <8, and that a pelvic lymph node dissection as an adjunctive procedure should be avoided in such individuals.