Is pelvic lymph node dissection necessary in patients with a serum PSA < 10 ng/ml undergoing radical prostatectomy for prostate cancer?

Objective: Controversy persists concerning the role of pelvic lymph node dissection (PLND) in patients with preoperative PSA values < 10 ng/ml undergoing treatment for prostate cancer with a curative intent. The aim of this study was to determine the incidence of lymph node metastasis in this subgroup of patients. Methods: Patients with clinically localized prostate cancer and a serum PSA < 10 ng/ml, without neoadjuvant hormonal or radiotherapy, with negative staging examinations who underwent radical retropubic prostatectomy with bilateral extended PLND and with >= 10 lymph nodes detected by the pathologist in the surgical specimen, were included in the study. Results: A total of 231 patients with a median serum PSA of 6.7 ng/ml (range 0.4-9.98) and a median age of 62 years (range 44-76) were evaluated. A median of 20 (range 10-72) nodes were removed per patient. Positive nodes were found in 26 of 231 patients (11%), the majority of which (81%) had a Gleason score >= 7 in the surgical specimen. of the patients with a Gleason score >= 7 in the prostatectomy specimen 25% had positive nodes, whereas only 3% with a Gleason score <= 6 were node positive. Conclusions: The incidence of positive nodes in patients with clinically localized prostate cancer, a serum PSA < 10 ng/ml and a Gleason score >= 7 in the prostatectomy specimen was 25% after extended PLND. It seems that in this patient group extended PLND, including removal of nodes along the internal iliac vessels, is warranted. (c) 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved.