First Nomogram Predicting the Probability of Lymph Node Involvement in Prostate Cancer Patients Undergoing Radioisotope Guided Sentinel Lymph Node Dissection

Abstract

Introduction: Existing nomograms predicting lymph node involvement (LNI) in prostate cancer (PCa) are based on conventional lymphadenectomy. The aim of the study was to develop the first nomogram for predicting LNI in PCa patients undergoing sentinel guided pelvic lymph node dissection (sPLND). Materials and Methods: Analysis was performed on 1,296 patients with PCa who underwent radioisotope guided sPLND and retropubic radical prostatectomy (2005-2010). Median prostate specific antigen (PSA): 7.4 ng/ml (IQR 5.3-11.5 ng/ml). Clinical T-categories: T1: 54.8%, T2: 42.4%, T3: 2.8%. Biopsy Gleason sums: ≤6: 55.1%, 7: 39.5%, ≥8: 5.4%. Multivariate logistic regression models tested the association between all of the above predictors and LNI. Regression-based coefficients were used to develop a nomogram for predicting LNI. Accuracy was quantified using the area under the curve (AUC). Results: The median number of LNs removed was 10 (IQR 7-13). Overall, 17.8% of patients (n = 231) had LNI. The nomogram had a high predictive accuracy (AUC of 82%). All the variables were statistically significant multivariate predictors of LNI (p = 0.001). Univariate predictive accuracy for PSA, Gleason sum and clinical stage was 69, 75 and 69%, respectively. Conclusions: The sentinel nomogram can predict LNI at a sPLND very accurately and, for the first time, aid clinicians and patients in making important decisions on the indication of a sPLND. The high rate of LN+ patients underscores the sensitivity of sPLND.

Updated Nomogram Incorporating Percentage of Positive Cores to Predict Probability of Lymph Node Invasion in Prostate Cancer Patients Undergoing Sentinel Lymph Node Dissection

“…In 2015, we reported the first sPLND-based nomogram, including the preoperative PSA, clinical category, and the Gleason sum as predictors for LNI 24 . Until now, it was the only available nomogram predicting LNI in prostate cancer patients based on sPLND.…”

“…99m technetium nanocolloid was transrectally injected 24 h before surgery into the prostate with ultrasound guidance 24 . Three injections were performed per prostate lobe.…”

“…Therefore, a nomogram for predicting LNI in prostate cancer patients undergoing sPLND was developed 24 . This first sentinel nomogram could highly accurately predict LNI at a sPLND, and for the first time assist clinicians and patients in making important decisions upon indication of a sPLND.…”

Is the Post-Radical Prostatectomy Gleason Score a Valid Predictor of Mortality after Neoadjuvant Hormonal Treatment?

“…Since the Gleason score is the most important prognostic parameter in patients with prostate cancer [4,8,9,10,11], the absence of the prognostic information delivered by the Gleason score makes it difficult to counsel patients on their mortality risk and on adjuvant treatment options. Furthermore, retrospective series may contain patients with neoadjuvant hormonal treatment in whom the validity of postoperatively assigned Gleason score may be of concern.…”

Urotensin II Receptor on Preoperative Biopsy is Associated with Upstaging and Upgrading in Prostate Cancer

“…[5]. The biopsy Gleason score has also been included in models predicting organ-confined disease [6] as well as lymph node involvement [7], and it is associated with outcome even in patients with advanced disease receiving systemic treatment [8,9].Preoperative staging underestimates pathologic stage and prostate biopsies underestimate the Gleason score compared with prostatectomy specimens in up to 66% of patients, depending on PSA levels, biopsy Gleason score and clinical stage [10]. Apart from these variables, which have been incorporated in a validated predictive model to predict Gleason upgrading [11], a number of biomolecular markers were associated with Gleason upgrading [12,13].…”