Prognostic Significance of Lymph Nodal Metastases in Prostate Cancer

Gervasi, Lawrence; Mata, John A.; Easley, James D.; Wilbanks, John H.; Seale‐Hawkins, Carie; Carlton, C. Eugene; Scardino, Peter T.

doi:10.1016/s0022-5347(17)38748-7

Cited by 302 publications

(103 citation statements)

References 12 publications

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“…8 The results with primary radiation therapy are similar. In the largest series, 9 5-and 10-year metastasis-free survivals were 32 and 17%, respectively, with a 10-year overall survival of 32%. In more contemporary series utilizing biochemical follow-up, the best results 10 report a 5-year biochemical disease-free survival of 77% with radiation alone.…”

Section: Discussionmentioning

confidence: 86%

Long-term outcome for lymph node-positive prostate cancer

Swanson

Riggs

Herman

2007

Prostate Cancer Prostatic Dis

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Although the number of men with lymph node-positive prostate cancer has declined, it is still significant and the challenge remains on how best to treat these patients. Only long-term follow-up can give a true indication of the outcome in prostate cancer. We evaluated our experience in treating lymph node-positive prostate cancer with a median follow-up of 10.2 years. The overall 5-year survival was 78% and the 10-year survival was 56%. Length of tumor control depends on the type of treatment given. Adding androgen ablation improves the duration of control dramatically, although optimal timing is still uncertain.

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Section: Discussionmentioning

confidence: 86%

Long-term outcome for lymph node-positive prostate cancer

Swanson

Riggs

Herman

2007

Prostate Cancer Prostatic Dis

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“…The risk of dying of prostate cancer at 10 years is much higher for patients with positive nodes than for patients with negative nodes [71] . Pretreatment knowledge of prostate cancer LNM is important for patient counseling and appropriate treatment selection and planning.…”

Section: Detection Of Lnmmentioning

confidence: 99%

Incremental value of magnetic resonance imaging in the advanced management of prostate cancer

Wang¹

2009

WJR

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Prostate cancer is a major public health burden throughout the world. The high incidence of prostate cancer, combined with earlier detection and downstaging at the time of diagnosis, and the slow natural progression and biological heterogeneity of the disease, has made its management a complex and controversial issue. There is growing demand for patient-specific therapies that can minimize treatment morbidity while maximizing treatment benefits. There are a number of clinical parameters and clinical nomograms to help with the choice of treatment. Magnetic resonance imaging (MRI) is a technique which makes safer, more individualized therapies possible due to high spatial resolution, superior contrast resolution, multiplanar capability, and a large field of view. Other MRI techniques such as MR spectroscopic imaging, dynamic contrast-enhanced MRI or perfusion MRI, and diffusion-weighted imaging complement MRI by reflecting tissue biochemistry, Brownian motion of water molecules, and capillary wall permeability, respectively. This editorial review highlights the incremental value of MRI in the advanced management of prostate cancer to non-invasively improve cancer staging, biologic potential, treatment planning, therapy response, local recurrence, and to guide target biopsy for clinical suspected cancer with previous negative biopsy. Finally, some future prospects for MRI in prostate cancer management are given.

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“…[1][2][3] Standard imagining techniques consistently have failed to identify pelvic lymph node spread with sufficient specificity. 4 -6 Even microscopic invasion substantially reduces biochem-ical and progression free survival.…”

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confidence: 99%

“…4 -6 Even microscopic invasion substantially reduces biochem-ical and progression free survival. 1 Therefore, correct preoperative assessment of the pelvic lymph node status is essential.…”

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confidence: 99%

“…Even though lymphadenectomy does not increase the time of surgery substantially, it can be associated with significant morbidity and mortality [7][8][9] when it is performed at the time of RRP or using a laparoscopic approach. 10 With the introduction of prostate specific antigen (PSA) screening for the early detection of PCa, a steady decrease in the number of patients with advanced PCa has been observed; in parallel, the incidence of lymph node metastases has declined continuously from 20 to 30% in the 1970s and 1980s 1,5 to Ͻ 5% in several large clinical series today. 11,12 The low incidence of lymph node metastasis in conjunction with the increasingly detailed evaluation of patients with early stage PCa has led to concerns that routine pelvic lymphadenectomy may represent surgical overtreatment in the vast majority of patients.…”

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confidence: 99%

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Validation of a biopsy‐based pathologic algorithm for predicting lymph node metastases in patients with clinically localized prostate carcinoma

Haese

Epstein

Huland

et al. 2002

Cancer

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BACKGROUNDThe authors validated an algorithm for the preoperative prediction of lymph node (LN) metastases in patients with clinically localized prostate carcinoma. The algorithm was applied to sextant biopsy material and radical retropubic prostatectomy (RRP) stage obtained from a cohort of men who were treated at the authors' institution.METHODSFour hundred forty‐three patients underwent systematic sextant biopsy and RRP with staging lymphadenectomy. The original algorithm was based on systematic sextant biopsy data and classified patients into three risk groups for LN metastases based on the biopsy result. If ≥ 4 of 6 biopsies contained any Gleason Pattern 4 disease, then the patient was at high risk for LN metastases (45%). Patients with ≥ 1 of 6 biopsies with dominant Gleason Pattern 4 disease (excluding high‐risk patients) had an intermediate predicted risk (19%) of LN metastases. All other patients had a low predicted risk of LN metastases (2.2%). The authors assed the percentage of patients who were positive and negative for LN metastases and calculated the specificity and negative predictive value in the series when patients were classified according to the original algorithm.RESULTSTwenty of 443 patients had intraoperative LN metastases. When applied to the current data, the Hamburg algorithm classified 404 patients in the low‐risk group, 30 patients in the intermediate‐risk group, and 9 patients in the high risk group. The incidence of LN metastases was 2.47% in the low‐risk group, 20% in the intermediate‐risk group, and 44.4% in the high‐risk group. The negative predictive value for the low‐risk group was 97.52%, and the specificity was 94.14%.CONCLUSIONSThe Hamburg algorithm proved a valid tool for the prediction of lymphatic spread in this validation study on data from the authors' institution. The algorithm may serve as a tool to select patients who do not need to undergo pelvic lymphadenectomy at the time they undergo RRP, hence reducing morbidity and expense. More importantly, with the increasing numbers of men undergoing treatment options in whom LN dissection is not performed, this validated algorithm provides an important selection basis regarding the appropriateness of a therapy that does not routinely include LN staging. Cancer 2002;95:1016–21. © 2002 American Cancer Society.DOI 10.1002/cncr.10811

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Prognostic Significance of Lymph Nodal Metastases in Prostate Cancer

Cited by 302 publications

References 12 publications

Long-term outcome for lymph node-positive prostate cancer

Long-term outcome for lymph node-positive prostate cancer

Incremental value of magnetic resonance imaging in the advanced management of prostate cancer

Validation of a biopsy‐based pathologic algorithm for predicting lymph node metastases in patients with clinically localized prostate carcinoma

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