Validation of a nomogram predicting the probability of lymph node invasion based on the extent of pelvic lymphadenectomy in patients with clinically localized prostate cancer

Briganti, Alberto; Chun, Felix K.-H.; Salonia, Andrea; Gallina, Andrea; Farina, Elena; Pozzo, L. Da; Rigatti, Patrìzio; Montorsi, Francesco; Karakiewicz, Pierre I.

doi:10.1111/j.1464-410x.2006.06318.x

Cited by 155 publications

(106 citation statements)

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“…Previous reports have shown complication rates for limited/standard PLND in the range of 2%-9.8%, whereas extended PLND complication rates varied in the range of 19.8%-75% [8 -10]. As expected, the most frequently reported complication is lymphocele formation, with rates in the range of 4.6%-10.6% [3,10]. As would be expected, performance at high-volume centers of excellence as well as a higher level of surgical experience usually results in lower complication rates.…”

Section: Complications Of Plndmentioning

confidence: 58%

“…Similarly, Briganti et al [3] proceeded to develop and validate a nomogram for prostate cancer that predicts the probability of lymph node metastases based on clinical parameters. With the majority of patients included in that study qualifying as low-risk patients and with only 9% (a total of 71 patients) having lymph node metastases, this rather small number limits its significance and accuracy.…”

Section: Preoperative Assessment Of Pelvic Lymph Nodes Nomogramsmentioning

confidence: 99%

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Indications, Extent, and Benefits of Pelvic Lymph Node Dissection for Patients with Bladder and Prostate Cancer

2009

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Target audience: Physicians who wish to advance their current knowledge of clinical cancer medicine in genitourinary cancer. LEARNING OBJECTIVES1. Evaluate all patients undergoing radical pelvic surgery to determine whether they should have pelvic lymph node dissection.2. Determine to what extent a pelvic lymph node dissection should be performed and analyze the risks involved.3. Based on best practices, assess whether pelvic lymph node dissection is beneficial for staging and prognosis.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTThe role of pelvic lymph node dissection (PLND) in both bladder and prostate cancer has recently been generating renewed interest. In an attempt to avoid PLND, both nomograms and imaging studies have been evaluated; however, so far they have shown limited success because of inadequate accuracy in staging patients. The three primary objectives of this review are: to define patients in whom PLND should be performed, to define the extent and consequences of the template for PLND, and to identify the staging and prognostic benefits seen with PLND in bladder and prostate cancer. Based on the findings from this review, we conclude that PLND for bladder cancer patients is undoubtedly beneficial, whereas it is less so for prostate cancer patients, in whom a selection strategy should be employed. PLND, in particular with an extended template, seems to provide superior accuracy for postoperative staging than the presently available imaging studies and may be pivotal when considering adjuvant therapies. Furthermore, it has an impact on survival in high-risk patients, and potentially more so in low-risk cancer patients with occult metastases.

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Section: Complications Of Plndmentioning

confidence: 58%

Section: Preoperative Assessment Of Pelvic Lymph Nodes Nomogramsmentioning

confidence: 99%

Indications, Extent, and Benefits of Pelvic Lymph Node Dissection for Patients with Bladder and Prostate Cancer

2009

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“…Meanwhile the current European Association of Urology guidelines are more moderate and recommend that patients with higher than 7% risk of LN metastases undergo PLND [4]. It is estimated that patients with D'Amico low risk prostate cancer have a risk of LN metastases of less than 7% [10]. However, the risk of LN metastases in patients with a Gleason score ≥ 7 is 25% [11].…”

Section: Methodsmentioning

confidence: 99%

“…There is debate in the literature as to who would benefit from PLND and the extent of the PLND. The 2010 National Comprehensive Cancer Network guidelines state that any patient with a 2% risk of LN metastases should undergo PLND [10]. Meanwhile the current European Association of Urology guidelines are more moderate and recommend that patients with higher than 7% risk of LN metastases undergo PLND [4].…”

Section: Methodsmentioning

confidence: 99%

453 Implications of Laparoscopic Inguinal Hernia Repair on Open, Laparoscopic and Robotic Radical Prostatectomy

Spernat¹,

Woo²,

Sofield³

et al. 2011

European Urology Supplements

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Purpose:There have been anecdotal reports of surgeons having to abandon radical prostatectomy (RP) after laparoscopic inguinal hernia repair (LIHR) due to obliteration of tissue planes by mesh. Nodal dissection may also be compromised. We prospectively collected data from four experienced prostate surgeons from separate institutions. Our objective was to evaluate the success rate of performing open RP (ORP), laparoscopic RP (LRP) and robotic assisted RP (RALRP) and pelvic lymph node dissection (PLND) after LIHR, and the frequency of complications. Methods:A retrospective analysis of prospectively maintained databases of men who underwent RP after LIHR between 2004 and 2010 at four institutions was undertaken. The data recorded included age, preoperative prostate-specific antigen, preoperative Gleason score, and clinical stage. The operative approach, success or failure to perform RP, success or failure to perform PLND, pathological stage, and complications were also recorded.Results: A total of 1,181 men underwent RP between 2004 and 2010. Fifty-seven patients (4.8%) underwent RP after LIHR. An ORP was attempted in 19 patients, LRP in 33, and RALRP in 5. All 57 cases were able to be successfully completed. Ten of the 18 open PLND were able to be completed (55.6%). Four of the 22 laparoscopic LND were able to be completed (18.2%). Robotic LND was possible in 5 of 5 cases (100%). Therefore, it was not possible to complete a LND 56.8% of patients. Complications were limited to ten patients. These complications included one LRP converted to ORP due to failure to progress, and one rectourethral fistula in a salvage procedure post failed high intensity focused ultrasound. Conclusions:LIHR is an increasingly common method of treating inguinal hernias. LIHR is not a contra-indication to RP. However PLND may not be possible in over 50% of patients who have had LIHR. Therefore, these patients may be under-staged and under treated.

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“…23 A pelvic lymph node dissection should be performed during RP for high-risk prostate cancer, as 15% to 40% will be positive. 24 If positive lymph nodes are found, ADT can be commenced, which has been shown, albeit in the pre-PSA era, to improve survival. 25 High-risk patients may subsequently experience local treatment failure and require adjuvant or salvage therapies.…”

Section: Discussionmentioning

confidence: 99%

Radical prostatectomy for high-risk clinically localized prostate cancer: a prospective single institution series

Koupparis

Grummet

Hurtado-Coll

et al. 2011

cuaj

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E156Cite as: Can Urol Assoc J 2011;5(6):E156-E161; http://dx.doi.org/10.5489/cuaj.10057. Epub 2011 Mar 1. AbstractObjective: The objective of this paper is to report on the pathologic and biochemical progression-free outcomes of patients who underwent radical prostatectomy for high-risk localized prostate cancer. Methods: Data was collected prospectively from 299 patients who underwent radical prostatectomy for high-risk clinically localized prostate cancer by 2 surgeons at a single institution. High risk was defined as 1 or more of 3 adverse factors: prostate-specific antigen (PSA) >20, biopsy Gleason score 8 to 10 and clinical stage T3. PSA recurrence was defined as PSA >0.4 ng/mL or any salvage therapy. Results: Median age was 63.3 years (46.1-75.9). Median followup was 4.7 years (range 0.5-17.3 years). PSA at diagnosis was >20 ng/mL in 31.4%. Biopsy Gleason score was 8 to 10 in 66.9%. Clinical stage was T3 in 24.4%. 81.6% of patients had a single baseline risk factor, 15.7% had 2 risk factors and 2.7% had all 3 risk factors. Neoadjuvant therapy was administered to 184 patients (61.5%). Pathologic stage was organ-confined in 39.6%, specimenconfined in 26%, non-specimen-confined in 26.4%, and 8% had lymph node positive disease. Overall survival, cancer-specific survival and biochemical progression-free survival was 99%, 99.67% and 70.2%, respectively. Univariate analysis showed that PSA at diagnosis, percentage of cores positive and number of risk factors were predictors of PSA recurrence (p < 0.05). Multivariate analysis showed that PSA at diagnosis was an independent predictor of PSA recurrence (p < 0.05). Conclusion: Radical prostatectomy is associated with favourable biochemical progression-free, clinical and overall survival in selected men with high-risk localized prostate cancer, and should therefore be considered an option in these patients. Baseline PSA >20 ng/mL is a significant independent predictor of PSA recurrence. RésuméObjectif : L'objectif de cet article est de faire rapport sur les résultats quant à la survie sans progression pathologique et biochimique des patients ayant subi une prostatectomie radicale pour traiter un cancer de la prostate localisé à risque élevé. Méthodologie : Les données ont été recueillies de manière prospective chez 299 patients ayant subi une prostatectomie radicale réalisée par 2 chirurgiens dans un même établissement pour traiter un cancer de la prostate à risque élevé cliniquement localisé. Un risque élevé était défini comme au moins 1 des 3 facteurs négatifs suivants : taux d'antigène prostatique spécifique (APS) > 20, score de Gleason de 8 à 10 à la biopsie, stade clinique T3. Une récidive avec anomalie de l'APS a été définie comme un taux d'APS > 0,4 ng/mL ou le recours à tout traitement de sauvetage. Résultats : L'âge médian était de 63,3 ans (46,1 à 75,9). Le suivi médian était de 4,7 ans (0,5 à 17,3 ans). Le taux d'APS au moment du diagnostic était > 20 ng/mL chez 31,4 % des patients. Le score de Gleason à la biopsie était de 8 à 10 dans 66,9 % des cas. Le st...

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Validation of a nomogram predicting the probability of lymph node invasion based on the extent of pelvic lymphadenectomy in patients with clinically localized prostate cancer

Cited by 155 publications

References 40 publications

Indications, Extent, and Benefits of Pelvic Lymph Node Dissection for Patients with Bladder and Prostate Cancer

Indications, Extent, and Benefits of Pelvic Lymph Node Dissection for Patients with Bladder and Prostate Cancer

453 Implications of Laparoscopic Inguinal Hernia Repair on Open, Laparoscopic and Robotic Radical Prostatectomy

Radical prostatectomy for high-risk clinically localized prostate cancer: a prospective single institution series

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