Pelvic Lymph Node Metastasis from Prostatic Cancer: Influence of Tumor Grade and Stage in 452 Consecutive Patients

Abstract

During the last decade 452 patients underwent pelvic lymphadenectomy as a staging procedure for apparently localized prostatic cancer. Of these patients 105 (23%) had pelvic node metastasis. Node involvement occurred in no patient with a stage A1, 24% with stage A2, 12% with stage B1, 28% with stage B2 and 53% with stage C tumor. Correlation with tumor grade revealed nodal metastasis in 10% of the patients with well differentiated tumors, 24% with moderately differentiated lesions and 54% with poorly differentiated tumors. The incidence of positive nodes is low enough to preclude lymphadenectomy in patients with stage A1 (0%) and well differentiated stage B1 tumors (4%), and high enough to assume metastatic disease without lymphadenectomy in those with poorly differentiated stage C tumors (93%). All other patients with apparently localized prostatic cancer should undergo a staging pelvic node dissection before definitive treatment.