Reliability of preoperative diagnostics and location of lymph node metastases in presumed unilateral prostate cancer

Abstract

564 men with impalpable or unilateral palpable prostate cancer and positive biopsy cores only in one prostate lobe had a radical prostatectomy (RP) combined with radioguided PLND and in some cases an extended PLND. RESULTSA median of six sentinel LNs (mean, seven) and six non-sentinel LNs (mean, seven) were dissected per patient; 52 of 564 men (9.2%) had positive LNs. Most men with unilateral disease had LN metastases on the same side of the pelvis. Comparing the clinical stage and grade with the tumour stage and grade of the RP specimen, there was a high percentage of upstaging and upgrading even in men with only one positive biopsy core. CONCLUSIONUnilateral prostate cancer preferentially metastasizes to the ipsilateral pelvic LNs. Because there are a few cases of bilateral LN metastases even in unilateral disease, and as it is not possible to reliably predict unilateral disease on the basis of biopsy features, PLND only on the tumour-bearing side has a high risk of understaging, and would possibly leave LN metastases behind.

Can side-specific biopsy findings predict the side of nodal metastasis in clinically localized prostate cancer? Results from a multicenter prospective survey

“…7,8 A study applying the sentinel lymphnode (LN) technique revealed a side-specific tropism of the metastatic dissemination in PCa and that unilateral prostate cancer preferentially metastasizes to ipsilateral pelvic LNs. 9 However, even if unilateral node dissection would reduce operating time, costs and morbidity, the dissection of sole LNs on the tumor-bearing side in men with unilateral PCa is not considered adequate. 10 Indeed, an assessment of the side of PCa based on biopsy results is not sufficiently accurate to evaluate the side of pathological PCa and the metastatic spread of PCa does not always follow a predictable pattern.…”

Contemporary Results of Focal Therapy for Prostate Cancer Using Cryoablation

“…By collecting more data on the tumor biology of unilateral disease, the critical aspects of this entity may be gradually unveiled. For instance, Weckermann and coworkers 45 investigated the data of 564 men with cT 1c or unilateral palpable disease with positive biopsy cores only in one lobe who underwent RP with some cases of pelvic node dissection. They found that unilateral PCa preferentially metastasized to the ipsilateral pelvic lymph nodes.…”

“…Furthermore, because a proportion of PCas now being diagnosed are unifocal, unilateral, or of lower malignant potential (''clinically insignificant''), this has raised questions as to whether all patients need radical treatment. [1][2][3][4][5][6] According to CaPSURE data, the proportion of patients with favorable or low-risk tumor characteristics has risen from 29.8% in 1989 to1992 to 45.3% in 1999 to 2001. Moreover, this tendency is being accelerated today with the implementation of extended and multicore prostate biopsy.…”

Advances in sentinel node dissection in prostate cancer from a technical perspective

“…1a). [23][24][25][26][27][28][29][30][31] The main advantage of this technique is that the images are generated easily and quickly, and give a direct overview over the radioactive hotspots. A disadvantage is that SN located near the site of injection can become obscured by the radioactive signal coming from the injection site.…”

“…Although, unilateral PCa tend to metastasize the ipsilateral side, bilateral PLND should be recommended. 30 Some studies reported the laparoscopic SN biopsy as a staging procedure before radiotherapy. These studies demonstrated that the SN procedure is a reliable tool for staging with high accuracy and minimal complications when comparing the ePLND.…”