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Bilateral lymph node micrometastases and seminal vesicle invasion associated with same clinical predictors in localized prostate cancer

Abstract

Aim

To determine clinical factors associated with multiple bilateral lymph node micrometastases and seminal vesicle invasion (pT3b) in organ-confined prostate cancer (PCa).

Methods

The study excluded patients under androgen deprivation, with lymph node involvement (cN1 status), and having undergone unilateral pelvic lymph node dissection (PLND) during radical prostatectomy (RP). Lymph node micrometastases were classified as unilateral (pN1m) and bilateral (pN1b). Analysis considered multivariate multinomial logistic regression models.

Results

Between January 2013 and March 2015, 140 patients underwent PLND during RP. Lymph node micrometastases were detected in 28 cases (20%) including pN1m in 19 (13.6%) and pN1b in 9 (6.4%). Independent clinical predictors of pN1b included prostate-specific antigen (PSA, µg/L) >12.5 (odds ratio [OR] = 43.0), proportion of positive biopsy cores (PBC) >0.57 (OR = 6.7), and biopsy Gleason grade (bGG) >3 (OR = 7.5). Independent pT3b predictors included PSA>12.5 (OR = 3.8), PBC>0.57 (OR = 4.1), and bGG>3 (OR = 3.8).

Conclusions

In cN0 patients with localized PCa undergoing PLND, a nonnegligible rate of multiple lymph node micrometastases was detected (32.2%). In the natural history of PCa, there is a close association between pT3b and pN1b disease. Prostate cancer patients who are at high risk of extraglandular extension need selective pelvic staging by multiparametric magnetic resonance imaging to assess seminal vesicle invasion. Operated patients with pT3b and pNx status need close PSA monitoring because of the high probability of occult multiple bilateral lymph node micrometastases.

Tumori 2017; 103(3): 299 - 306

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/tj.5000546

Authors

Antonio B. Porcaro, Nicolò de Luyk, Paolo Corsi, Marco Sebben, Alessandro Tafuri, Irene Tamanini, Tania Processali, Maria A. Cerruto, Filippo Migliorini, Matteo Brunelli, Salvatore Siracusano, Walter Artibani

Article History

Disclosures

Financial support: None.
Conflict of interest: None.

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Authors

Affiliations

  • Urology Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy
  • Department of Pathology, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona - Italy

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