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Créhange G, Chen CP, Hsu CC, Kased N, Coakley FV, Kurhanewicz J, Roach M. Management of prostate cancer patients with lymph node involvement: a rapidly evolving paradigm. Cancer Treat Rev 2012; 38:956-67. [PMID: 22703831 DOI: 10.1016/j.ctrv.2012.05.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 05/15/2012] [Accepted: 05/17/2012] [Indexed: 11/17/2022]
Abstract
Although widespread PSA screening has inevitably led to increased diagnosis of lower risk prostate cancer, the number of patients with nodal involvement at baseline remains high (nearly 40% of high risk patients initially staged cN0). These rates probably do not reflect the true incidence of prostate cancer with lymph node involvement among patients selected for external beam radiotherapy (EBRT), as patients selected for surgery often have more favorable prognostic features. At many institutions, radical treatment directed only at the prostate is considered standard and patients known to have regional disease are often managed palliatively with androgen deprivation therapy (ADT) for presumed systemic disease. New imaging tools such as MR lymphangiography, choline-based PET imaging or combined SPECT/CT now allow surgeons and radiation oncologists to identify and target nodal metastasis and/or lymph nodes with a high risk of occult involvement. Recent advances in the field of surgery including the advent of extended nodal dissection and sentinel node procedures have suggested that cancer-specific survival might be improved for lymph-node positive patients with a low burden of nodal involvement when managed with aggressive interventions. These new imaging tools can provide radiation oncologists with maps to guide delivery of high dose conformal radiation to a target volume while minimizing radiation toxicity to non-target normal tissue. This review highlights advances in imaging and reports how they may help to define a new paradigm to manage node-positive prostate cancer patients with a curative-intent.
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Affiliation(s)
- Gilles Créhange
- Department of Radiation Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 1600 Divisadero Street, CA-94143, San Francisco, United States.
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102
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Robotic Extended Pelvic Lymphadenectomy for Intermediate- and High-Risk Prostate Cancer. Eur Urol 2012; 61:1004-10. [PMID: 22366188 DOI: 10.1016/j.eururo.2012.01.048] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 01/27/2012] [Indexed: 11/24/2022]
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103
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Kjölhede H, Ahlgren G, Almquist H, Liedberg F, Lyttkens K, Ohlsson T, Bratt O. Combined18F-fluorocholine and18F-fluoride positron emission tomography/computed tomography imaging for staging of high-risk prostate cancer. BJU Int 2012; 110:1501-6. [DOI: 10.1111/j.1464-410x.2012.11123.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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104
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Godoy G, von Bodman C, Chade DC, Dillioglugil O, Eastham JA, Fine SW, Scardino PT, Laudone VP. Pelvic lymph node dissection for prostate cancer: frequency and distribution of nodal metastases in a contemporary radical prostatectomy series. J Urol 2012; 187:2082-6. [PMID: 22498221 DOI: 10.1016/j.juro.2012.01.079] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Indexed: 10/28/2022]
Abstract
PURPOSE We determined the frequency and distribution of metastases to pelvic lymph nodes in a contemporary American radical prostatectomy series. MATERIALS AND METHODS In 642 consecutive patients with clinically localized prostate cancer treated by a single surgeon between 2002 and 2009 pelvic lymph nodes were removed and submitted to the pathologist in separate packets (external iliac, obturator and hypogastric). We assessed the total number of nodes and the number with metastases in each packet. RESULTS Complete pathological information was available for 427 patients, who had a median of 16 lymph nodes removed. Of the patients 35 (8.2%) had lymph node metastases, including 1.7% with low, 8.6% with intermediate and 23.9% with high risk cancer. Of those with nodal metastases 24 (69%) had positive lymph nodes in only 1 of the 3 areas, including the external iliac in 4 (11%), the obturator in 9 (26%) and the hypogastric in 11 (31%). Only 37% of the patients had positive nodes only in the external iliac area above the obturator nerve while 60% and 49% had at least 1 positive node in the obturator and the hypogastric area, respectively. Of the patients 80% had only 1 (49%) or 2 (31%) positive nodes. CONCLUSIONS In contemporary American patients with clinically localized prostate cancer lymph node metastases were found more often and frequently exclusively in the obturator and hypogastric areas than in the external iliac area. Pelvic lymph node dissection limited to the external iliac area above the obturator nerve would identify and remove lymph node metastases in only a third of the patients with positive nodes found at full pelvic lymph node dissection.
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Affiliation(s)
- Guilherme Godoy
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA
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105
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Walz J, Bladou F, Rousseau B, Laroche J, Salem N, Gravis G, Briganti A, Chun FKH, Karakiewicz PI, Fournier G. Head to Head Comparison of Nomograms Predicting Probability of Lymph Node Invasion of Prostate Cancer in Patients Undergoing Extended Pelvic Lymph Node Dissection. Urology 2012; 79:546-51. [DOI: 10.1016/j.urology.2011.11.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 11/19/2011] [Accepted: 11/19/2011] [Indexed: 10/28/2022]
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106
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Adams J, Cheng L. Lymph node-positive prostate cancer: current issues, emerging technology and impact on clinical outcome. Expert Rev Anticancer Ther 2012; 11:1457-69. [PMID: 21929319 DOI: 10.1586/era.11.104] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lymph node metastasis in patients with prostate cancer indicates a poorer prognosis compared with patients without lymph node metastasis; however, some patients with node-positive disease have long-term survival. Many studies have attempted to discern what characteristics of lymph node metastasis are prognostically significant. These characteristics include nodal tumor volume, number of positive lymph nodes, lymph node density, extranodal extension, lymphovascular invasion and tumor dedifferentiation. Favorable characteristics of regional lymph node involvement included a smaller tumor size and smaller tumor volume. However, the current staging system for prostate cancer does not provide different subclassifications for patients with node-positive prostate cancer. In recent years numerous advanced technologies for the detection of lymph node metastasis have been developed, including molecular imaging techniques and the CellSearch Circulating Tumor Cell System. With the increased detection of patients with prostate cancer, emergence of new technology to identify lymph node metastasis and the number of radical prostatectomies being performed on the rise, subclassifying patients with lymph node-positive disease is imperative. Subclassification would provide a better picture of patient prognosis and allow for a better understanding of targeted therapies to treat patients with lymph node metastasis.
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Affiliation(s)
- Julia Adams
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, 350 West 11th Street, IUHPL 4010, Indianapolis, IN 46202, USA
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107
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Briganti A, Suardi N, Capogrosso P, Passoni N, Freschi M, di Trapani E, Gallina A, Capitanio U, Abdollah F, Tutolo M, Bianchi M, Salonia A, Da Pozzo LF, Montorsi F, Rigatti P. Lymphatic spread of nodal metastases in high-risk prostate cancer: The ascending pathway from the pelvis to the retroperitoneum. Prostate 2012; 72:186-92. [PMID: 21538428 DOI: 10.1002/pros.21420] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 04/14/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND The aim of this study was to map the nodal metastases distribution in patients with high-risk prostate cancer (PCa) treated with extended pelvic lymph node dissection (ePLND) and retroperitoneal lymph node dissection (rLND) at the time of radical prostatectomy (RP). MATERIALS AND METHODS This prospective mapping study included 19 patients with high-risk PCa (sharing at least two out of the three following parameters: PSA >20 ng/ml, cT3, biopsy Gleason score ≥8). All patients were treated with RP, ePLND (removal of the obturator, hypogastric, external iliac, presacral, and common iliac lymph nodes) and rLND (removal of para-aortal/para-caval and inter-aorto-caval lymph nodes) by a single surgeon. All patients signed an informed consent highlighting the absence of clinical data supporting the benefit of this surgical approach. RESULTS Overall, 18 out of 19 patients (94.7%) had pelvic lymph node invasion. The most commonly affected pelvic nodal landing site was obturator (88.8%), followed by external iliac (83.3%), common iliac (77%), hypogastric (44.4%), and presacral (33.3%). Moreover, 14 (77.8%) patients also had involvement of retroperitoneal lymph nodes. Only patients with positive common iliac lymph nodes having at least five positive lower pelvic lymph nodes (n = 14), also had invariably positive retroperitoneal lymph nodes. No patients with negative common iliac lymph nodes had positive retroperitoneal lymph nodes. CONCLUSIONS PCa lymphatic spread ascends from the pelvis up to the retroperitoneum invariably through common iliac lymph nodes. PCa lymphatic spread can be divided in two main levels: pelvic and common iliac plus retroperitoneal lymph nodes.
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Affiliation(s)
- Alberto Briganti
- Department of Urology, Vita-Salute University San Raffaele, Milan, Italy.
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108
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Silberstein JL, Vickers AJ, Power NE, Parra RO, Coleman JA, Pinochet R, Touijer KA, Scardino PT, Eastham JA, Laudone VP. Pelvic lymph node dissection for patients with elevated risk of lymph node invasion during radical prostatectomy: comparison of open, laparoscopic and robot-assisted procedures. J Endourol 2011; 26:748-53. [PMID: 22050490 DOI: 10.1089/end.2011.0266] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Published outcomes of pelvic lymph node dissection (PLND) during robot-assisted laparoscopic prostatectomy (RALP) demonstrate significant variability. The purpose of the study was to compare PLND outcomes in patients at risk for lymph node involvement (LNI) who were undergoing radical prostatectomy (RP) by different surgeons and surgical approaches. PATIENTS AND METHODS Institutional policy initiated on January 1, 2010, mandated that all patients undergoing RP receive a standardized PLND with inclusion of the hypogastric region when predicted risk of LNI was ≥ 2%. We analyzed the outcomes of consecutive patients meeting these criteria from January 1 to September 1, 2010 by surgeons and surgical approach. All patients underwent RP; surgical approach (open radical retropubic [ORP], laparoscopic [LRP], RALP) was selected by the consulting surgeon. Differences in lymph node yield (LNY) between surgeons and surgical approaches were compared using multivariable linear regression with adjustment for clinical stage, biopsy Gleason grade, prostate-specific antigen (PSA) level, and age. RESULTS Of 330 patients (126 ORP, 78 LRP, 126 RALP), 323 (98%) underwent PLND. There were no significant differences in characteristics between approaches, but the nomogram probability of LNI was slightly greater for ORP than RALP (P=0.04). LNY was high (18 nodes) by all approaches; more nodes were removed by ORP and LRP (median 20, 19, respectively) than RALP (16) after adjusting for stage, grade, PSA level, and age (P=0.015). Rates of LNI were high (14%) with no difference between approaches when adjusted for nomogram probability of LNI (P=0.15). Variation in median LNY among individual surgeons was considerable for all three approaches (11-28) (P=0.005) and was much greater than the variability by approach. CONCLUSIONS PLND, including hypogastric nodal packet, can be performed by any surgical approach, with slightly different yields but similar pathologic outcomes. Individual surgeon commitment to PLND may be more important than approach.
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Affiliation(s)
- Jonathan L Silberstein
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA
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109
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Davis JW, Shah JB, Achim M. Robot-assisted extended pelvic lymph node dissection (PLND) at the time of radical prostatectomy (RP): a video-based illustration of technique, results, and unmet patient selection needs. BJU Int 2011; 108:993-8. [PMID: 21917102 DOI: 10.1111/j.1464-410x.2011.10454.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE • To describe the differences in technique and results between standard vs extended template pelvic lymph node dissection (PLND) at the time of radical prostatectomy (RP) using a robot-assisted (RA) technique. PATIENTS AND METHODS • Using extended templates illustrated for the open surgical technique, a RA technique was developed to solve obstacles related to surgical exposure, identification of key landmarks, proper sequencing of operative steps, and prevention of complicationsshown in the accompanying video. • From May 2006 to October 2007, 261 patients underwent a standard PLND, and from November 2007 to November 2010, 670 underwent an extended PLND (E-PLND) by one surgeon. RESULTS • The lymph node (LN) yield increased from a median(interquartile range) of 8 (5-11) to 16 (11-21) with the extended technique (P < 0.001). • The ratio of positive LNs increased from 7% to 18%. Among E-PLND cases by risk group, positive LNs were found in 39%, 9%, and 3% of high-, intermediate-, and low-risk cases, and the later two groups strongly associated with upgrading and/or upstaging. • Extensive clipping appears necessary to avoid postoperative lymphoceles, and peritoneal fenestration for the extraperitoneal technique. • The median operative duration for E-PLND was 42 min, roughly double that of a standard PLND. CONCLUSIONS • E-PLND is feasible with a RA technique, and increases the LN yield and positive LN ratio;the latter especially in high-risk disease. • The procedure takes twice as long and requires several updates in technique shown in the video.
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Affiliation(s)
- John W Davis
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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110
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Mazzola C, Savage C, Ahallal Y, Reuter VE, Eastham JA, Scardino PT, Guillonneau B, Touijer KA. Nodal counts during pelvic lymph node dissection for prostate cancer: an objective indicator of quality under the influence of very subjective factors. BJU Int 2011; 109:1323-8. [DOI: 10.1111/j.1464-410x.2011.10610.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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111
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Sense and nonsense of an extended pelvic lymph node dissection in prostate cancer. Adv Urol 2011; 2012:983058. [PMID: 22007203 PMCID: PMC3189454 DOI: 10.1155/2012/983058] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 08/12/2011] [Indexed: 11/17/2022] Open
Abstract
Lymph node metastases associated with prostate cancer (PCa) has been shown to be a poor prognostic factor. The role of pelvic lymph node dissection (PLND) itself in relation to survival remains unclear, however. A Medline search was conducted to address this issue. The following conclusions were drawn. Only recently, improved survival due to completion of radical prostatectomy (RP) (compared to abandoning RP) in known or presumed lymph-node-positive patients has been shown. Lymph node sampling can only be considered representative if an adequate number of nodes is removed. While several authors have suggested that a therapeutic benefit in patients undergoing RP is not provided by PLND, the reliability of these studies is uncertain. Contrary to this, several studies have indicated the possibility of long-term survival even in the presence of limited lymph node metastases. The role and timing of initiation of adjuvant androgen deprivation therapy (ADT) in patients who have node-positive disease after RP is controversial. Recent studies suggest that delaying ADT may not adversely impact survival.
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112
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Godoy G, Chong KT, Cronin A, Vickers A, Laudone V, Touijer K, Guillonneau B, Eastham JA, Scardino PT, Coleman JA. Extent of Pelvic Lymph Node Dissection and the Impact of Standard Template Dissection on Nomogram Prediction of Lymph Node Involvement. Eur Urol 2011; 60:195-201. [DOI: 10.1016/j.eururo.2011.01.016] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 01/08/2011] [Indexed: 10/18/2022]
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113
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Womble PR, VanVeldhuizen PJ, Nisbet AA, Reed GA, Thrasher JB, Holzbeierlein JM. A phase II clinical trial of neoadjuvant ketoconazole and docetaxel chemotherapy before radical prostatectomy in high risk patients. J Urol 2011; 186:882-7. [PMID: 21791342 DOI: 10.1016/j.juro.2011.04.087] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE Patients with high risk prostate cancer (prostate specific antigen greater than 20 ng/ml, Gleason score greater than 7, or clinical stage T2b or greater) have been shown to have a 30% to 40% biochemical recurrence rate after definitive local therapy. Looking for improvement on these outcomes, we conducted a phase II clinical trial examining the combination of ketoconazole and docetaxel in the neoadjuvant setting before radical prostatectomy. MATERIALS AND METHODS A total of 22 patients with clinically localized, high risk prostate cancer were enrolled in the study. For 12 weeks they were treated with neoadjuvant docetaxel and ketoconazole, with dosing based on phase I data. Patients were monitored for tolerance of therapy and dosing adjustments were made for significant toxicities. Radical prostatectomy with extended lymph node dissection was subsequently performed and patients were followed postoperatively for biochemical recurrence. RESULTS At a median followup of 18 months 8 patients remained biochemically free of recurrence after surgery alone. An additional 6 patients received salvage therapy and had an undetectable prostate specific antigen. Of the 22 patients 16 experienced National Cancer Institute grade 3 or 4 toxicity at some point during the therapy. However, 16 patients completed all 4 cycles of chemotherapy. CONCLUSIONS Neoadjuvant ketoconazole combined with docetaxel has appreciable but acceptable toxicity with 73% of the patients completing all 4 courses of therapy. Of those who underwent radical prostatectomy 36% remained continuously biochemically free of recurrence at a median followup of 18 months.
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Affiliation(s)
- Paul R Womble
- Department of Urology, University of Kansas Hospital, University of Kansas Medical Center, Kansas City, Kansas 66160, USA
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114
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Joung JY, Cho IC, Lee KH. Role of pelvic lymph node dissection in prostate cancer treatment. Korean J Urol 2011; 52:437-45. [PMID: 21860762 PMCID: PMC3151629 DOI: 10.4111/kju.2011.52.7.437] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 03/07/2011] [Indexed: 11/18/2022] Open
Abstract
Pelvic lymph node dissection (PLND) is the most accurate and reliable staging procedure for detecting lymph node invasion (LNI) in prostate cancer. Recently, [(11)C]-choline positron emission tomography imaging and magnetic resonance imaging with lymphotropic superpara-magnetic nanoparticles have shown potential for detecting LNI but are still under investigation. The risk of LNI in low-risk groups could be underestimated by use of the current nomograms, which rely on data collected from patients who underwent only limited PLND. Extended PLND (ePLND) shows higher lymph node yield, which leads to the removal of more positive nodes and fewer missed positive nodes. It may be possible to refrain from performing PLND on low-risk patients with a prostate-specific antigen value <10 ng/ml and a biopsy Gleason score ≤6, but the risk of biopsy-related understaging should be kept in mind. Theoretically, meticulous ePLND may also impact prostate cancer survival by clearing low-volume diseases and occult micrometastasis even in pN0. The therapeutic role of PLND in prostate cancer patients is still an open question, especially in individuals with low-risk disease. Patients with intermediate- to high-risk disease are more likely to benefit from ePLND.
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Affiliation(s)
- Jae Young Joung
- Center for Prostate Cancer, National Cancer Center, Goyang, Korea
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115
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Vesey SG, McCabe JE, Hounsome L, Fowler S. UK radical prostatectomy outcomes and surgeon case volume: based on an analysis of the British Association of Urological Surgeons Complex Operations Database. BJU Int 2011; 109:346-54. [DOI: 10.1111/j.1464-410x.2011.10334.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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116
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Chin JL, Srigley J, Mayhew LA, Rumble RB, Crossley C, Hunter A, Fleshner N, Bora B, McLeod R, McNair S, Langer B, Evans A. Guideline for optimization of surgical and pathological quality performance for radical prostatectomy in prostate cancer management: evidentiary base. Can Urol Assoc J 2011; 4:13-25. [PMID: 20165572 DOI: 10.5489/cuaj.08105] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The objective is to provide surgical and pathological guidelines for radical prostatectomy (RP) with or without concurrent pelvic lymph node dissection (PLND) to achieve optimal benefit for patients, with minimal risk of harm. METHODS For surgical questions, a literature search of MEDLINE, EMBASE and the Cochrane database was performed. A literature search for the pathological questions was not conducted since the protocol for invasive carcinomas of the prostate gland developed by the College of American Pathologists (CAP) was endorsed. Urologists and pathologists were consulted for their assessment of the surgical and pathological recommendations. RESULTS Limited high-quality evidence from 95 primary studies was available and, therefore, the expert panel developed recommendations on the basis of a consensus of the expert opinion of the working group and through a consultation with urologists and pathologists. In addition to the CAP protocol, some technical recommendations related to the handling and processing of the specimen were made. CONCLUSION Radical prostatectomy is recommended for the surgical treatment of prostate cancer, depending on a patient's preoperative risk profile. The panel unanimously determined that the goals for RP are to attain a positive margin rate of <25% for pT2 disease, a mortality rate of <1%, rates of rectal injury of <1% and blood transfusion rates of <10% in non-anemic patients. Standard PLND should be mandatory in high-risk patients, should be recommended for intermediate-risk patients and should be optional for low-risk patients. The quality and effectiveness of this treatment and of subsequent patient care depend on good management, effective communication and reporting between surgeons and pathologists working together as part of a multidisciplinary team. The complete guideline document is posted on the Cancer Care Ontario website (www.cancercare.on.ca); search in their Toolbox, Quality Guidelines & Standards, Clinical Program category under "surgery."
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Affiliation(s)
- Joseph L Chin
- Regional Head of Surgical Oncology, London Health Sciences Centre, London, ON
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117
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Bodin T, Boutin JM, Haillot O, Bruyere F. Le curage ilio-obturateur dans le cancer de la prostate doit-il être réalisé par voie cœlioscopique ? Prog Urol 2011; 21:463-9. [DOI: 10.1016/j.purol.2010.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 10/18/2010] [Accepted: 10/31/2010] [Indexed: 10/18/2022]
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118
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Roach M, Alberini JL, Pecking AP, Testori A, Verrecchia F, Soteldo J, Ganswindt U, Joyal JL, Babich JW, Witte RS, Unger E, Gottlieb R. Diagnostic and therapeutic imaging for cancer: therapeutic considerations and future directions. J Surg Oncol 2011; 103:587-601. [PMID: 21480253 DOI: 10.1002/jso.21805] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
As cancer treatment cost soar and the mantra for "personalized medicine" grows louder, we will increasingly be searching for solutions to these diametrically opposed forces. In this review we highlight several exciting novel imaging strategies including MRI, CT, PET SPECT, sentinel node, and ultrasound imaging that hold great promise for improving outcomes through detection of lymph node involvement. We provide clinical data that demonstrate how these evolving strategies have the potential to transform treatment paradigms.
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Affiliation(s)
- Mack Roach
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA.
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119
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Miki J, Egawa S. The role of lymph node dissection in the management of prostate cancer. Int J Clin Oncol 2011; 16:195-202. [PMID: 21556799 DOI: 10.1007/s10147-011-0245-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Indexed: 11/28/2022]
Abstract
Lymph node dissection is a standard procedure for treatment of several cancers, but its role in prostate cancer (PCa) as an adjunct of radical prostatectomy is still debated and controversial. Pelvic lymph node dissection (PLND) is currently the most reliable means of diagnosis of lymph node metastases. A uniform PLND surgical template cannot be determined, but recent evidence shows that extended PLND provides more lymph nodes, increases the accuracy of detection of lymph node metastases, and affects decision making with regard to adjuvant therapy. Several nomograms have been developed to predict those who may need more extensive PLND, while sparing the rest. Importantly, no prospective data indicate that extension of PLND improves cancer control or benefits survival. A well designed prospective randomized study is needed to resolve these issues. We present a comprehensive literature review and critical discussion of the diagnostic and therapeutic role of PLND in PCa.
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Affiliation(s)
- Jun Miki
- Department of Urology, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo 105-8461, Japan.
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120
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Briganti A, Karnes RJ, Pozzo LFD, Cozzarini C, Capitanio U, Gallina A, Suardi N, Bianchi M, Tutolo M, Salonia A, Di Muzio N, Rigatti P, Montorsi F, Blute M. Combination of Adjuvant Hormonal and Radiation Therapy Significantly Prolongs Survival of Patients With pT2–4 pN+ Prostate Cancer: Results of a Matched Analysis. Eur Urol 2011; 59:832-40. [DOI: 10.1016/j.eururo.2011.02.024] [Citation(s) in RCA: 166] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 02/13/2011] [Indexed: 11/25/2022]
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121
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Ganswindt U, Schilling D, Müller AC, Bares R, Bartenstein P, Belka C. Distribution of Prostate Sentinel Nodes: A SPECT-Derived Anatomic Atlas. Int J Radiat Oncol Biol Phys 2011; 79:1364-72. [DOI: 10.1016/j.ijrobp.2010.01.012] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 01/07/2010] [Accepted: 01/12/2010] [Indexed: 11/27/2022]
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122
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Gotto GT, Yunis LH, Guillonneau B, Touijer K, Eastham JA, Scardino PT, Rabbani F. Predictors of symptomatic lymphocele after radical prostatectomy and bilateral pelvic lymph node dissection. Int J Urol 2011; 18:291-6. [DOI: 10.1111/j.1442-2042.2010.02710.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Heidenreich A, Pfister D, Thüer D, Brehmer B. Percentage of positive biopsies predicts lymph node involvement in men with low-risk prostate cancer undergoing radical prostatectomy and extended pelvic lymphadenectomy. BJU Int 2011; 107:220-5. [DOI: 10.1111/j.1464-410x.2010.09485.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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124
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Tabasi K, Bazaz SMM, Kakhki VRD, Massoom AF, Gholami H, Zakavi SR, Sadeghi R. Sentinel node mapping in the prostate cancer. Nuklearmedizin 2011; 50:107-115. [DOI: 10.3413/nukmed-0339-10-07] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
SummaryAim: Sentinel node (SN) biopsy is becoming a standard procedure in the management of several malignancies. Several groups have evaluated the feasibility and value of this procedure in prostate cancer patients. In the current meta-analysis, we comprehensively and quantitatively summarized the results of these studies. Methods: Several databases including Medline, SCOPUS, Google Scholar, Ovid, Springer, and Science direct were systematically searched for the relevant studies regarding SL biopsy in the prostate cancer (“prostate” AND “sentinel” as search keywords). The outcomes of interest were sensitivity and detection rate of the procedure. Results: For detection rate and sensitivity 21 and 16 studies met the criteria of inclusion respectively. Pooled detection rate was 93.8% (95% CI 89–96.6%). Cochrane Q value was 216.077 (I2 = 89.81% and p < 0.001). Pooled sensitivity was 94% (95% CI 91–96%). Cochrane Q value was 14.12 (I2 = 0.0 and p = 0.516). Conclusion: SL biopsy can prevent unnecessary pelvic lymph node dissection in prostate cancer patients. This procedure is feasible with low false negative rate and high detection rate.
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125
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van Leeuwen AC, Buckle T, Bendle G, Vermeeren L, Valdés Olmos R, van de Poel HG, van Leeuwen FWB. Tracer-cocktail injections for combined pre- and intraoperative multimodal imaging of lymph nodes in a spontaneous mouse prostate tumor model. JOURNAL OF BIOMEDICAL OPTICS 2011; 16:016004. [PMID: 21280910 DOI: 10.1117/1.3528027] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
To improve surgical guidance toward prostate draining lymph nodes, we investigate the potential of intraoperative fluorescence imaging and combined pre- and intraoperative multimodality imaging approaches. Transgenic adenocarcinoma mouse prostate mice with spontaneous prostate tumors are injected intratumorally with: 1. a cocktail of patent blue (Pb) and indocyanine green (ICG); 2. a cocktail of albumin radiocolloids (99mTc-NanoColl), Pb, and ICG; or 3. a cocktail of radiolabeled albumin (99mTc-Vasculosis), Pb, and ICG. The distribution of these imaging agents over the lymph nodes (LNs) are studied at different time points after injection. We find that at 60-min postinjection, ICG significantly improves the detection of the LNs compared to Pb, 53 versus 7%, respectively. Moreover, a cocktail of ICG and 99mTc-NanoColl improves the fluorescent detection rate to 86%, equalling that of the clinically applied 99mTc-NanoColl. A similar overlap is observed in our initial clinical pilot data. Fluorescent detection of the LNs using a ICG with 99mTc-Vasculosis gives similar results as "free" ICG (58%; 60 min). A 99mTc-NanoColl, Pb, and cocktail ICG enriches the standard 99mTc-NanoColl approach by adding optical detection of the sentinel lymph nodes. Furthermore, this approach improves fluorescent-based guidance and enables both accurate surgical planning and intraoperative detection, based on a single injection.
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Affiliation(s)
- Anne C van Leeuwen
- Antoni van Leeuwenhoek Hospital, Division of Diagnostic Oncology, 1066 CX Amsterdam, The NetherlandsAntoni van Leeuwenhoek Hospital, Division of Immunology, 1066 CX Amsterdam, The NetherlandsAntoni van Leeuwenhoek Hospital, Netherlands Cancer Institute, Division of Surgical Oncology, 1066 CX Amsterdam, The Netherlands
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126
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Siemens DR. Why all prostate cancer surgery should include an adequate lymph node dissection. Can Urol Assoc J 2010; 4:427-9. [PMID: 21191508 DOI: 10.5489/cuaj.10185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- D Robert Siemens
- Associate Professor, Departments of Urology, Oncology, Anatomy and Cell Biology, Queen's University, Kingston, ON
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127
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Touijer K, Fuenzalida RP, Rabbani F, Paparel P, Nogueira L, Cronin AM, Fine SW, Guillonneau B. Extending the indications and anatomical limits of pelvic lymph node dissection for prostate cancer: improved staging or increased morbidity? BJU Int 2010; 108:372-7. [PMID: 21199284 DOI: 10.1111/j.1464-410x.2010.09877.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Karim Touijer
- Department of Surgery, Service of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Abstract
UNLABELLED Pelvic lymph node (LN) metastasis is a well-recognized route of prostate cancer spread. However, the relationship between topography and the pathologic features of primary prostatic cancers and patterns of pelvic LN metastasis has not been well studied. We reviewed original slides of radical prostatectomies and pelvic LN dissections from 125 patients with LN metastasis and recorded a total number of LN excised/laterality of positive LN, and localization, staging parameters, lymphovascular invasion, and volume of primary tumors. LN QUANTITY AND DISTRIBUTION 14.6 (mean) and 13 (median) LNs were resected. Seventy-six (61%), 33 (26%), and 16 (13%) cases had 1, 2, and >2 positive LNs; whereas 58, 44, and 20 cases had LN metastasis on the right, left, and bilaterally. PATHOLOGIC FEATURES Eighty-six percent (108 of 125) and 37% (46 of 125) of the cases showed extraprostatic extension and seminal vesicle invasion, whereas 64% cases showed lymphovascular invasion. Mean and median total tumor volumes were 6.39 and 3.92 cm, with ≥50% and ≥90% Gleason patterns 4/5 in 105 (84%) and 73 (58%) cases, respectively. CORRELATION WITH DOMINANT TUMOR LOCATION Dominant lesions on radical prostatectomy were as follows: 50 right lobe, 44 left lobe, and 31 bilateral lobe tumors. Fifteen of 50 (30%) right lobe and 18 of 44 (41%) left lobe dominant tumors had LN metastasis on the contralateral side. Only 4% (5 of 125) of the cases were associated with anterior dominant tumors. CONCLUSION Thirty percent to 40% of LN metastases occurred contralateral to the dominant tumor. LN metastasis is overwhelmingly associated with high-grade, high-stage, and large volume disease. LN positivity is rarely associated with anterior dominant tumors.
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129
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Adkison JB, McHaffie DR, Bentzen SM, Patel RR, Khuntia D, Petereit DG, Hong TS, Tomé W, Ritter MA. Phase I trial of pelvic nodal dose escalation with hypofractionated IMRT for high-risk prostate cancer. Int J Radiat Oncol Biol Phys 2010; 82:184-90. [PMID: 21163590 DOI: 10.1016/j.ijrobp.2010.09.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 09/20/2010] [Accepted: 09/24/2010] [Indexed: 01/22/2023]
Abstract
PURPOSE Toxicity concerns have limited pelvic nodal prescriptions to doses that may be suboptimal for controlling microscopic disease. In a prospective trial, we tested whether image-guided intensity-modulated radiation therapy (IMRT) can safely deliver escalated nodal doses while treating the prostate with hypofractionated radiotherapy in 5½ weeks. METHODS AND MATERIALS Pelvic nodal and prostatic image-guided IMRT was delivered to 53 National Comprehensive Cancer Network (NCCN) high-risk patients to a nodal dose of 56 Gy in 2-Gy fractions with concomitant treatment of the prostate to 70 Gy in 28 fractions of 2.5 Gy, and 50 of 53 patients received androgen deprivation for a median duration of 12 months. RESULTS The median follow-up time was 25.4 months (range, 4.2-57.2). No early Grade 3 Radiation Therapy Oncology Group or Common Terminology Criteria for Adverse Events v.3.0 genitourinary (GU) or gastrointestinal (GI) toxicities were seen. The cumulative actuarial incidence of Grade 2 early GU toxicity (primarily alpha blocker initiation) was 38%. The rate was 32% for Grade 2 early GI toxicity. None of the dose-volume descriptors correlated with GU toxicity, and only the volume of bowel receiving ≥30 Gy correlated with early GI toxicity (p = 0.029). Maximum late Grades 1, 2, and 3 GU toxicities were seen in 30%, 25%, and 2% of patients, respectively. Maximum late Grades 1 and 2 GI toxicities were seen in 30% and 8% (rectal bleeding requiring cautery) of patients, respectively. The estimated 3-year biochemical control (nadir + 2) was 81.2 ± 6.6%. No patient manifested pelvic nodal failure, whereas 2 experienced paraaortic nodal failure outside the field. The six other clinical failures were distant only. CONCLUSIONS Pelvic IMRT nodal dose escalation to 56 Gy was delivered concurrently with 70 Gy of hypofractionated prostate radiotherapy in a convenient, resource-efficient, and well-tolerated 28-fraction schedule. Pelvic nodal dose escalation may be an option in any future exploration of potential benefits of pelvic radiation therapy in high-risk prostate cancer patients.
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Affiliation(s)
- Jarrod B Adkison
- Department of Human Oncology, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, Madison, WI 53792, USA
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130
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Abdollah F, Sun M, Thuret R, Budäus L, Jeldres C, Graefen M, Briganti A, Perrotte P, Rigatti P, Montorsi F, Karakiewicz PI. Decreasing Rate and Extent of Lymph Node Staging in Patients Undergoing Radical Prostatectomy May Undermine the Rate of Diagnosis of Lymph Node Metastases in Prostate Cancer. Eur Urol 2010; 58:882-92. [DOI: 10.1016/j.eururo.2010.09.029] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Accepted: 09/16/2010] [Indexed: 10/19/2022]
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131
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Re: Predicting biochemical recurrence-free survival for patients with positive pelvic lymph nodes at radical prostatectomy: C. Von Bodman, G. Godoy, D. C. Chade, A. Cronin, L. J. Tafe, S. W. Fine, V. Laudone, P. T. Scardino and J. A. Eastham J Urol 2010; 184: 143-148. J Urol 2010; 185:360-1; author reply 361. [PMID: 21092995 DOI: 10.1016/j.juro.2010.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Indexed: 11/21/2022]
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132
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Capitanio U, Pellucchi F, Gallina A, Briganti A, Suardi N, Salonia A, Abdollah F, Di Trapani E, Jeldres C, Cestari A, Karakiewicz PI, Montorsi F. How can we predict lymphorrhoea and clinically significant lymphocoeles after radical prostatectomy and pelvic lymphadenectomy? Clinical implications. BJU Int 2010; 107:1095-101. [PMID: 20880192 DOI: 10.1111/j.1464-410x.2010.09580.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE • To identify clinical and pathological variables that may help clinicians in predicting, preventing and managing lymphorrhoea and clinically significant lymphocoeles (CSL), which are reported complications after pelvic lymphadenectomy (PLND) and retropubic radical prostatectomy (RRP). PATIENTS AND METHODS • We prospectively analysed 552 consecutive men with prostate cancer who underwent RRP and PLND (2006-2008). • All patients had detailed clinical and pathological data prospectively recorded in an electronic database. Drains were removed when the amount of lymph was < 20 mL in the previous 24 h. A CSL was defined as the presence of a symptomatic lymphocoele requiring treatment. Lymphorrhoea was defined as the total amount of lymph drained by the drains until their removal. • Univariable and multivariable logistic regression models were used to test the association between all the predictors (age, body mass index, American Society of Anesthesiologists score, prostate volume, clinical stage, number of LNs removed, surgeon, pathological T and N stage) and the presence of CSL. • Univariable and multivariable linear regression models were also used to test the association between the available predictors and lymphorrhoea. RESULTS • The median (range) number of LNs removed was 20 (1-63). Both linear and logistic multivariable regression analysis showed that the number of removed LNs and age were the only two statistically significant predictors of total amount of lymphorrhoea and CSL after RRP and PLND (both P < 0.01). • Specifically, the risk of developing a CSL increased by 5% for every LN removed. Similarly, every year of age increased the risk of having CSL by 5%. • The most informative thresholds for predicting CSL were 65 years of age and 20 LNs removed. • External iliac lymphadenectomy resulted in a higher associated risk of lymphorrhoea and CLS relative to obturator LN removal (P= 0.001 vs P= 0.1, respectively). CONCLUSIONS • There was a positive association between the number of LNs removed and age at RRP with the amount of lymphorrhoea and the risk of developing a CSL. • The most informative thresholds in predicting CSL were 65 years of age and 20 LNs removed. External iliac lymphadenectomy resulted in a higher risk of lymphorrhoea and CLS relative to obturator LN removal.
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Affiliation(s)
- Umberto Capitanio
- Department of Urology, University Vita-Salute, San Raffaele Hospital, Milan, Italy.
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133
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Weizer AZ, Montgomery JS. The Role of Lymphadenectomy in Minimally Invasive Urologic Oncology. J Endourol 2010; 24:1229-40. [DOI: 10.1089/end.2009.0562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alon Z. Weizer
- Division of Urologic Oncology and Minimally Invasive Surgery, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Jeffrey S. Montgomery
- Division of Urologic Oncology and Minimally Invasive Surgery, Department of Urology, University of Michigan, Ann Arbor, Michigan
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134
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Eden C, Arora A. The number of negative pelvic lymph nodes removed does not affect the risk of biochemical failure after radical prostatectomy. BJU Int 2010; 105:1479-80. [PMID: 20518771 DOI: 10.1111/j.1464-410x.2010.09395_3.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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135
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von Bodman C, Godoy G, Chade DC, Cronin A, Tafe LJ, Fine SW, Laudone V, Scardino PT, Eastham JA. Predicting biochemical recurrence-free survival for patients with positive pelvic lymph nodes at radical prostatectomy. J Urol 2010; 184:143-8. [PMID: 20478587 DOI: 10.1016/j.juro.2010.03.039] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Indexed: 11/29/2022]
Abstract
PURPOSE We evaluated predictors of freedom from biochemical recurrence in patients with pelvic lymph node metastasis at radical prostatectomy. MATERIALS AND METHODS Of 207 patients with lymph node metastasis treated with radical prostatectomy and bilateral pelvic lymph node dissection 45 received adjuvant androgen deprivation therapy and 162 did not. Cox proportional hazards regression models were used to investigate predictors of biochemical recurrence after radical prostatectomy. Recurrence probability was estimated using the Kaplan-Meier method. RESULTS A median of 13 lymph nodes were removed. Of the patients 122 had 1, 44 had 2 and 41 had 3 or greater positive lymph nodes. Of patients without androgen deprivation therapy 103 had 1, 35 had 2 and 24 had 3 or greater positive lymph nodes while 69 experienced biochemical recurrence. Median time to recurrence in patients with 1, 2 and 3 or greater lymph nodes was 59, 13 and 3 months, respectively. Only specimen Gleason score and the number of positive lymph nodes were independent predictors of biochemical recurrence. Recurrence-free probability 2 years after prostatectomy in men without androgen deprivation with 1 positive lymph node and a prostatectomy Gleason score of 7 or less was 79% vs 29% in those with Gleason score 8 or greater and 2 or more positive lymph nodes. CONCLUSIONS Prognosis in patients with lymph node metastasis depends on the number of positive lymph nodes and primary tumor Gleason grade. Of all patients with lymph node metastasis 80% had 1 or 2 positive nodes. A large subset of those patients had a favorable prognosis. Full bilateral pelvic lymph node dissection should be done in patients with intermediate and high risk cancer to identify those likely to benefit from metastatic node removal.
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Affiliation(s)
- Christian von Bodman
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
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136
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Schilling D, Boekeler U, Gakis G, Schwentner C, Corvin S, Sotlar K, Müller AC, Bares R, Stenzl A. Modified concept for radioisotope-guided sentinel lymph node dissection in prostate cancer. World J Urol 2010; 28:715-20. [DOI: 10.1007/s00345-010-0533-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 03/05/2010] [Indexed: 11/25/2022] Open
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138
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Seitz M, Bader M, Strittmatter F, Gratzke C, Tilki D, Roosen A, Schlenker B, Reich O, Stief C. [Diagnostic work-up for lymph node metastases of urological tumors]. Urologe A 2010; 49:356-63. [PMID: 20213349 DOI: 10.1007/s00120-010-2271-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Both CT and MRI are currently the most frequently used and recommended modalities for lymph node staging of uro-oncological diseases. Their diagnostic usefulness is limited particularly for recognition of micrometastases and lymph nodes <10 mm. FDG- and choline-based PET/CT procedures also do not offer much improvement in these cases. Meanwhile however PET/CT has been included in the EAU guidelines for seminomas and is recommended for further management of residual tumors after chemotherapy. Magnetic resonance imaging with lymphotropic monocrystalline iron oxide nanoparticles appears to exhibit great potential and can detect smaller metastases and micrometastases even in normal-sized lymph nodes in uro-oncological diseases. Nevertheless, Guerbet has withdrawn its application to the EMEA for marketing authorization of its product Sinerem (superparamagnetic iron oxide nanoparticles). In the meantime diffusion-weighted MRI represents a promising technique and is already being evaluated in fields outside the realm of urology.
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Affiliation(s)
- M Seitz
- Urologische Klinik und Poliklinik, Klinikum der Universität München - Campus Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 München.
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Naselli A, Andreatta R, Introini C, Fontana V, Puppo P. Predictors of Symptomatic Lymphocele After Lymph Node Excision and Radical Prostatectomy. Urology 2010; 75:630-5. [DOI: 10.1016/j.urology.2009.03.011] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 02/21/2009] [Accepted: 03/08/2009] [Indexed: 11/28/2022]
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140
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141
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Eden CG, Arora A, Rouse P. Extended vs standard pelvic lymphadenectomy during laparoscopic radical prostatectomy for intermediate- and high-risk prostate cancer. BJU Int 2010; 106:537-42. [DOI: 10.1111/j.1464-410x.2009.09161.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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142
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Prostatic Lymphatic Drainage With Sentinel Nodes at the Ventral Abdominal Wall Visualized With SPECT/CT. Clin Nucl Med 2010; 35:71-3. [DOI: 10.1097/rlu.0b013e3181c7c07b] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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143
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Palapattu GS, Singer EA, Messing EM. Controversies Surrounding Lymph Node Dissection for Prostate Cancer. Urol Clin North Am 2010; 37:57-65, Table of Contents. [DOI: 10.1016/j.ucl.2009.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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144
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Katz DJ, Yee DS, Godoy G, Nogueira L, Chong KT, Coleman JA. Lymph node dissection during robotic-assisted laparoscopic prostatectomy: comparison of lymph node yield and clinical outcomes when including common iliac nodes with standard template dissection. BJU Int 2010; 106:391-6. [DOI: 10.1111/j.1464-410x.2009.09102.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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145
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146
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Cooperberg MR, Kane CJ, Cowan JE, Carroll PR. Adequacy of lymphadenectomy among men undergoing robot-assisted laparoscopic radical prostatectomy. BJU Int 2010; 105:88-92. [DOI: 10.1111/j.1464-410x.2009.08699.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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147
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Touijer K. Editorial comment on: oncologic outcome after extraperitoneal laparoscopic radical prostatectomy: midterm follow-up of 1115 procedures. Eur Urol 2009; 57:273. [PMID: 19775808 DOI: 10.1016/j.eururo.2009.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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148
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Simonato A, Varca V, Esposito M, Venzano F, Carmignani G. The use of a surgical patch in the prevention of lymphoceles after extraperitoneal pelvic lymphadenectomy for prostate cancer: a randomized prospective pilot study. J Urol 2009; 182:2285-90. [PMID: 19762048 DOI: 10.1016/j.juro.2009.07.033] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Indexed: 11/28/2022]
Abstract
PURPOSE Pelvic lymphadenectomy is frequently performed simultaneously with radical prostatectomy to determine lymph node status and the most frequently recorded postoperative complication is the development of a symptomatic lymphocele. This study evaluated TachoSil as an adjunct treatment in preventing lymphoceles after extraperitoneal pelvic lymphadenectomy for prostate cancer. MATERIALS AND METHODS A total of 60 consecutive patients who had undergone radical prostatectomy and pelvic lymphadenectomy were prospectively enrolled in this study. The patients were randomly assigned to a standard technique with the use of clips and electrocoagulation plus TachoSil, or to standard technique only. All patients underwent ultrasound examination on postoperative days 7, 14 and 28 to test for the development of symptomatic or asymptomatic lymphoceles. Drainage volume and duration were also recorded. RESULTS The baseline characteristics of the 2 randomized groups were well matched. Those patients in whom we used TachoSil showed a lower drainage volume with a mean total volume of 64 +/- 45 ml (range 0 to 110) vs 190 +/- 62.72 ml (range 70 to 270, p = 0.009), and had significantly fewer symptomatic and asymptomatic lymphoceles (5 vs 19, p = 0.001). Only 5 percutaneous surgical procedures to drain the lymphoceles proved necessary, 1 of which occurred in the group with TachoSil. CONCLUSIONS TachoSil seems to provide a useful additional treatment option for reducing drainage volume and preventing lymphocele development after extraperitoneal radical retropubic prostatectomy with pelvic lymphadenectomy.
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Affiliation(s)
- Alchiede Simonato
- Luciano Giuliani Institute of Urology, University of Genoa, Genoa, Italy.
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Chapet O, Quero L, Azria D, Bossi A, Hennequin C, Paparel P. L’irradiation pelvienne est-elle toujours justifiée dans le traitement des cancers de la prostate par irradiation exclusive ? Cancer Radiother 2009; 13:416-22. [DOI: 10.1016/j.canrad.2008.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Accepted: 11/09/2008] [Indexed: 11/17/2022]
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150
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Burkhard FC, Studer UE. Regional lymph node staging in prostate cancer: Prognostic and therapeutic implications. Surg Oncol 2009; 18:213-8. [DOI: 10.1016/j.suronc.2009.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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