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PSA density versus risk stratification for lymphadenectomy-making decision in patients with prostate cancer undergoing radical prostatectomy

  • Urology – Original Paper
  • Published:
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Abstract

Objectives

To determine the value of PSA density as independent predictor for lymph node invasion in order to decide lymphadenectomy in patients undergoing radical prostatectomy.

Patients and methods

We retrospectively analyzed the medical records of 179 patients who undergone radical prostatectomy from January 2001 until September 2010. Studied patients divided in groups regarding the preoperative risk for lymph node metastasis (low risk or not) and PSA density (≤.2 or greater). Age, prostate volume, preoperative PSA, and preoperative Gleason score (≤6 or ≥7) were estimated as well. We analyze the impact of the above factors in prediction of lymph nodes metastasis after radical prostatectomy.

Results

One patient found to have lymph node invasion out of 48 who stratified as low-risk patients and 1 out of 77 who had PSA density ≤.2. There was a significant correlation between preoperative PSA, PSA density, and risk stratification among patients who had metastasis or not. These findings confirmed in the univariate analysis of these factors. However, in multivariate analysis, PSA density was the only statistically significant predictor.

Conclusion

This is the first study to compare preoperative risk stratification and PSA density as predictors of lymph node metastasis in patients who are planned for radical prostatectomy. PSA density values ≤.2 can predict lymph nodes metastasis in a larger population of patients and consequently can potentially decrease the number of lymphadenectomies during radical prostatectomy procedures.

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References

  1. Bensalah K, Lotan Y, Karam JA et al (2008) New circulating biomarkers for prostate cancer. Prost Cancer Prost Dis 11:112–120

    Article  CAS  Google Scholar 

  2. Stephan C, Jung K, Lein M et al (2000) Molecular forms of prostate-specific antigen and human kallikrein 2 as promising tools for early diagnosis of prostate cancer. Cancer Epidemiol Biomarkers Prev 9:1133–1147

    PubMed  CAS  Google Scholar 

  3. Stamey TA, Yang N, Hay AR et al (1987) Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate. N Engl J Me 317:909–916

    Article  CAS  Google Scholar 

  4. Benson MC, Whang IS, Pantuck A et al (1992) Prostate specific antigen density: a means of distinguishing benign prostatic hypertrophy and prostate cancer. J Urol 147:815–816

    PubMed  CAS  Google Scholar 

  5. Benson MC, McMahon DJ, Cooner WH et al (1993) An algorithm for prostate cancer detection in a patient population using prostate-specific antigen and prostate-specific antigen density. World J Urol 11:206–213

    Article  PubMed  CAS  Google Scholar 

  6. Wolf JS Jr, Cher M, Dall’era M et al (1995) The use and accuracy of cross-sectional imaging and fine needle aspiration cytology for detection of pelvic lymph node metastases before radical prostatectomy. J Urol 153:993–999

    Article  PubMed  Google Scholar 

  7. Katz S, Rosen M (2006) MR imaging and MR spectroscopy in prostate cancer management. Radiol Clin North Am 44:723–734

    Article  PubMed  Google Scholar 

  8. Heidenreich A, Aus G, Bolla M et al (2008) EAU guidelines on prostate cancer. Eur Urol 53:68–80

    Article  PubMed  Google Scholar 

  9. Partin AW, Mangold LA, Lamm DM et al (2001) Contemporary update of prostate cancer staging nomograms (Partin Tables) for the new millennium. Urology 58:843–848

    Article  PubMed  CAS  Google Scholar 

  10. Wolff JM, Boeckmann W, Mattelaer P et al (1995) Determination of prostate gland volume by transrectal ultrasound: correlation with radical prostatectomy specimens. Eur Urol 28:10–12

    PubMed  CAS  Google Scholar 

  11. Parker CC, Husband J, Dearnaley DP (1999) Lymph node staging in clinically localized prostate cancer. Prostate Cancer Prostatic Dis 2:191–199

    Article  PubMed  Google Scholar 

  12. Palapattu GS, Allaf ME, Trock BJ et al (2004) Prostate specific antigen progression in men with lymph node metastases following radical prostatectomy: results of long-term followup. J Urol 172:1860–1864

    Article  PubMed  Google Scholar 

  13. Han M, Partin AW, Pound CR et al (2001) Longterm biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15-year Johns Hopkins experience. Urol Clin North Am 28:555–556

    Article  PubMed  CAS  Google Scholar 

  14. Messing EM, Manola J, Yao J et al (2006) Eastern Cooperative Oncology Group study EST 3886. Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy. Lancet Oncol 7:472–479

    Article  PubMed  CAS  Google Scholar 

  15. Makarov DV, Trock BJ, Humphreys EB et al (2007) Updated nomogram to predict pathologic stage of prostate cancer given prostate-specific antigen level, clinical stage, and biopsy Gleason score (Partin tables) based on cases from 2000 to 2005. Urology 69:1095–1101

    Article  PubMed  Google Scholar 

  16. Bhatta-Dhar N, Reuther AM, Zippe C et al (2004) No difference in six-year biochemical failure rates with or without pelvic lymph node dissection during radical prostatectomy in low-risk patients with localized prostate cancer. Urology 63:528–531

    Article  PubMed  Google Scholar 

  17. Weight CJ, Reuther AM, Gunn PW et al (2008) Limited pelvic lymph node dissection does not improve biochemical relapse-free survival at 10 years after radical prostatectomy in patients with low-risk prostate cancer. Urology 71:141–145

    Article  PubMed  Google Scholar 

  18. Berglund RK, Sadetsky N, DuChane J et al (2007) Limited pelvic lymph node dissection at the time of radical prostatectomy does not affect 5-year failure rates for low, intermediate and high risk prostate cancer: results from CaPSURE. J Urol 177:526–529

    Article  PubMed  Google Scholar 

  19. Shinohara K, Wolf JS Jr, Narayan P et al (1994) Comparison of prostate specific antigen with prostate specific antigen density for 3 clinical applications. J Urol 152:120–123

    PubMed  CAS  Google Scholar 

  20. Wolff JM, Boeckmann W, Effert PJ et al (1996) Clinical use of prostate-specific antigen and prostate-specific antigen density in the staging of patients with cancer of the prostate. Eur Urol 30:451–457

    PubMed  CAS  Google Scholar 

  21. Brassell SA, Kao TC, Sun L et al (2005) Prostate-specific antigen versus prostate-specific antigen density as predictor of tumor volume, margin status, pathologic stage, and biochemical recurrence of prostate cancer. Urology 66:1229–1233

    Article  PubMed  Google Scholar 

  22. Freedland SJ, Wieder JA, Jack GS et al (2002) Improved risk stratification for biochemical recurrence after radical prostatectomy using a novel risk group system based on prostate specific antigen density and biopsy Gleason score. J Urol 168:110–115

    Article  PubMed  Google Scholar 

  23. Wolff JM, Boeckmann W, Mattelaer P et al (1995) Determination of prostate gland volume by transrectal ultrasound: correlation with radical prostatectomy specimens. Eur Urol 28:10–12

    PubMed  CAS  Google Scholar 

  24. Briganti A, Chun FK, Salonia A et al (2006) 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. BJU Int 98:788–793

    Article  PubMed  Google Scholar 

  25. Touijer K, Rabbani F, Otero JR et al (2007) Standard versus limited pelvic lymph node dissection for prostate cancer in patients with a predicted probability of nodal metastasis greater than 1%. J Urol 178:120–124

    Article  PubMed  Google Scholar 

  26. Heidenreich A, Ohlmann CH, Polyakov S (2007) Anatomical extent of pelvic lymphadenectomy in patients undergoing radical prostatectomy. Eur Urol 52:29–37

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Urology Department, Patras University Hospital, Building A, 4th Floor, 26500, Rion, Patras, Greece

    Stavros Sfoungaristos & Petros Perimenis

Authors
  1. Stavros Sfoungaristos
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  2. Petros Perimenis
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Correspondence to Stavros Sfoungaristos.

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Sfoungaristos, S., Perimenis, P. PSA density versus risk stratification for lymphadenectomy-making decision in patients with prostate cancer undergoing radical prostatectomy. Int Urol Nephrol 43, 1073–1079 (2011). https://doi.org/10.1007/s11255-011-9942-9

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  • DOI: https://doi.org/10.1007/s11255-011-9942-9

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