Assessing the risk of lymph node invasion in patients with intermediate risk prostate cancer treated with extended pelvic lymph node dissection. A novel prediction tool

Alberto Briganti, Umberto Capitanio, Firas Abdollah, Andrea Gallina, Nazareno Suardi, Marco Bianchi, Manuela Tutolo, Andrea Salonia, Massimo Freschi, Patrizio Rigatti, Francesco Montorsi

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Controversy exists regarding the need for extended pelvic lymph node dissection (ePLND) in patients with intermediate risk prostate cancer (PCa). MATERIALS AND METHODS The study included 982 consecutive men with intermediate risk PCa (PSA 10-20ng/ml or cT2b-c or biopsy Gleason 3+4/ 4+3) treated with ePLND and radical prostatectomy (RP) at a single center. All patients underwent an anatomically defined ePLND. A novel risk stratification tool was developed by applying the nonparametric tree modeling technique of classification and regression tree analysis (CART) which relied on pre-operative PSA, clinical stage, biopsy Gleason score, and percentage of positive cores. The area under the receiver characteristic curve (AUC) method was used to quantify the accuracy of the model. Results: Lymph node invasion (LNI) was found in 81 (8.2%) patients. The CART analyses identified three risk groups of having LNI: a) Low risk: Gleason 3+3, cT1c/cT2, PSA 10-20ng/ml, or Gleason 3+4/4+3, ≤63% of positive cores and PSAa;circltcirng/ml (risk of LNI: 3.7 and 5.2%, respectively; 64.8% of patients included); b) Moderate risk: Gleason 3+3, a;circ63% of positive cores and PSA≤5ng/ml (risk of LNI:14.4%; 23% of patients included); c)High risk: Gleason 3+4/4+3, % positive cores >63% (risk of LNI:20.1%; 12.% of patients included; P

Original languageEnglish
Pages (from-to)499-506
Number of pages8
JournalProstate
Volume72
Issue number5
DOIs
Publication statusPublished - Apr 2012

Keywords

  • intermediate risk
  • lymph node metastasis
  • prediction model
  • prostate cancer

ASJC Scopus subject areas

  • Urology
  • Oncology

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