Predictive factors for lymph node positivity in patients undergoing extended pelvic lymphadenectomy during robot assisted radical prostatectomy

Abstract

Introduction:Pelvic lymphadenectomy during radical prostatectomy (RP) improves staging and may provide a therapeutic benefit. However, there is no clear consensus on the selection criteria for subjecting patients to this additional procedure. With a growing adoption of robot assisted radical prostatectomy (RARP) in India, it has become imperative to study the incidence and predictive factors for lymph node involvement in our patients.Materials and Methods:From February 2010 to February 2014, 452 RARP procedures were performed at our institution. A total of 100 consecutive patients from July 2011 to August 2012 were additionally subjected to a robotic extended pelvic lymphadenectomy (EPLND). Lymph node positivity rates and lymph node density were analyzed on the basis of preoperative prostate specific antigen (PSA), Gleason score, clinical stage, D’Amico risk category and magnetic resonance imaging (MRI) findings. Multivariate analysis was performed to ascertain factors associated with lymph node positivity in our cohort.Results:The mean age of the patients was 65.5 (47–77) years and the body mass index was 26.3 (16.3–38.7) kg/m2. The mean console time for EPLND was 45 (32–68) min. A median of 17 (two to 40) lymph nodes were retrieved. Seventeen patients (17%) had positive lymph nodes (median of 1, range 1–6). Median lymph node density in these patients was 10%. When stratified by PSA, Gleason score, clinical stage, D’Amico risk category and features of locally advanced disease on MRI, a trend towards increasing incidence of lymph node positivity was observed, with an increase in adverse factors. However, on multivariate analysis, clinical stage > T2a was the only significant factor impacting lymph node positivity in our cohort.Conclusions:A significant proportion of men undergoing RARP in India have positive lymph nodes on EPLND. While other variables may also have a potential impact, a higher clinical stage predisposes to an increased incidence of lymph node metastases.

Multiparametric magnetic resonance imaging-transrectal ultrasound fusion prostate biopsy: A prospective, single centre study

“…The demographic and characteristics of disease are different in India. Batra et al .,[ 14 ] showed that the majority of Indian patients had higher stage prostate disease (93% patients had intermediate and high-risk D' Amico category prostate cancer).…”

MRI and 11C acetate PET/CT for prediction of regional lymph node metastasis in newly diagnosed prostate cancer

“…A few studies have evaluated the diagnostic performance of this tracer, in lymph node staging at initial diagnosis of PCa, with ePLND as reference standard. 30 , 31 , 32 Sensitivity ranged from 61% to 82% and specificity from 84% to 95% in these studies. The sensitivity of 68 Ga-PSMA PET/CT is higher, but specificity is somewhat lower, compared to 11 C acetate PET/CT.…”

“…Another recent study by Batra et al . 30 investigated predictive factors for LN metastases in 100 patients undergoing ePLND. Variables examined in simple logistic regression analysis were PSA, Gleason score, clinical stage, D’Amico risk category and features of locally advanced disease on MRI (defined as extraprostatic extension, seminal vesicle invasion and enlarged pelvic lymph nodes).…”

When the limited pelvic lymph node dissection in prostate cancer patients can be justified?

“…Current research has shown a tendency to find ways to minimize the volume of PLND. Among them there is the study of the diagnostic efficiency of sentinel node biopsy (SNB) [9]. Given the anatomical features of the lymphatic drainage of the prostate, the volume of limited PLND may not include sentinel lymph nodes [12].…”