Association of Lymphovascular Invasion with Lymph Node Metastases in Prostate Cancer-Lateralization Concept

Simple Summary: Prostate cancer (PCa) patients often face uncertainties in treatment decisions, particularly regarding lymphadenectomy. This study, involving 96 PCa patients, explores the significance of lymphovascular invasion (LVI) laterality in influencing lymph node invasion (LNI) patterns. Out of these patients, 63.5% exhibited LVI exclusively on the left, 25.0% on the right, and 11.5% on both sides. Significant correlations were observed between LVI laterality and lymph node involvement (p < 0.001), especially on the right side. Left-sided LVI correlated with higher cancer stage (p = 0.047) and greater odds of bilateral lymph node involvement. This pioneering study emphasizes the need for future prospective, multi-center investigations, ideally incorporating preoperative LVI assessment, to refine PCa treatment decisions. Background. Lymphovascular invasion (LVI) is a vital but often overlooked prognostic factor in prostate cancer. As debates on lymphadenectomy's overtreatment emerge, understanding LVI laterality gains importance. This study pioneers the investigation into PCa, aiming to uncover patterns that could influence tailored surgical strategies in the future. Methods. Data from 96 patients with both LVI and lymph node invasion (LNI) were retrospectively analyzed. All participants underwent radical prostatectomy (RP) with modified-extended pelvic lymph node dissection (mePLND). All specimens underwent histopathological examination. The assessment of LVI was conducted separately for the right and left lobes of the prostate. Associations within subgroups were assessed using U-Mann-Whitney and Kruskal-Wallis tests, as well as Kendall's tau-b coefficient, yielding p-values and odds ratios (ORs). Results. Out of the 96 patients, 61 (63.5%) exhibited exclusive left-sided lymphovascular invasion (LVI), 24 (25.0%) had exclusive right-sided LVI, and 11 (11.5%) showed bilateral LVI. Regarding nodal involvement, 23 patients (24.0%) had LNI solely on the left, 25 (26.0%) exclusively on the right, and 48 (50.0%) on both sides. A significant correlation was observed between lateralized LVI and lateralized LNI (p < 0.001), particularly in patients with right-sided LVI only. LN-positive patients with left-sided LVI tended to have higher pT stages (p = 0.047) and increased odds ratios (OR) of bilateral LNI (OR = 2.795; 95% confidence interval [CI]: 1.231-6.348) compared to those with exclusive right-sided LVI (OR = 0.692; 95% CI: 0.525-0.913). Conclusions. Unilateral LVI correlates with ipsilateral LNI in PCa patients with positive LNs, notably in cases of exclusively right-sided LVI. Left-sided LVI associates with higher pT stages and a higher percentage of bilateral LNI cases.