Laparoscopic staging of prostatic carcinoma

Abstract

Current treatment of prostate cancer is highly controversial, however accurate assessment of pelvic lymph node status is important to determine early in the course of therapy if adjuvant hormonal ablation is necessary. Indications for laparoscopic assessment of pelvic lymph nodes are now better defined and the technique requires a high degree of technical skill and expertise. A series of 50 patients who underwent laparoscopic pelvic lymphadenectomy is presented. A greater than 40% chance of node positivity was found in a group of patients who had either a clinical stage B2, C, DO, or a prostate-specific antigen level greater than 40 ng/dl, or a total Gleason score of 7, 8, 9, or 10. Laparoscopic pelvic lymphadenectomy remains the current method to accurately stage lymph node involvement in prostate carcinoma.

Laparoscopy for diagnosis and staging of malignancy

“…Most indications for pelvic lymphadenectomy are within the realm of urologic and gynecologic surgery. Several reports evaluating laparoscopic pelvic lymphadenectomy for staging prostate cancer have shown significant benefits, which include decreased pain, decreased hospital stay, and decreased use of laparotomy [46,47]. Laparoscopic pelvic and retroperitoneal lymphadenectomies have been used for staging other urologic tumors, such as bladder [48], penile [48,49], and non-seminomatous testicular cancers [50].…”

The Role of Laparoscopy in Prostate Cancer Staging

“…Several studies have attempted to define the low-risk, high-risk, or multiple-risk groups in an effort to guide clinician and patient in deciding the need for pretreatment nodal staging (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). A summary of 12 of these studies is shown in Table 1.…”

Laparoscopic surgery for cancer patients

“…Most indications for pelvic lymphadenec‐tomy are within the realm of urologic and gynecologic surgery. Several reports evaluating laparoscopic pelvic lymphadenectomy for staging prostate cancer have shown significant benefits, which include decreased pain, decreased hospital stay, and decreased use of laparotomy 50,51 . Laparoscopic pelvic and retroperitoneal lymphadenectomies have been used for staging other urologic tumors, such as bladder, 52 penile, 52,53 and nonseminoma‐tous testicular cancers 54 …”