Laparoscopic pelvic lymph node dissection in the staging of prostate cancer

Background: Men with localized prostate cancer who present with high risk features may benefit from determination of pelvic lymph node status by a laparoscopic lymph node dissection prior to definitive therapy. Methods: One hundred eighty-nine men with a median age of 69 years (range 49-80) with T1-T3 prostate cancer had a laparoscopic pelvic lymph node dissection (LPLND) prior to definitive therapy (radiation or surgery). All patients had a negative bone scan and a computerized tomography of the pelvis prior to the LPLND. In addition, all patients also underwent a seminal vesicle biopsy (SVB) in order to determine the presence of T3c disease. Prostate-specific antigen (PSA) ranged from 1.6-190 ng/mL (median 11 ng/mL) and was > 10 ng/mL in 56.6%, Gleason score was greater than or equal to 7 in 46.7%, and 67.8% had clinical stage T2b-T3a. Results: Of the 189 patients who underwent an LPLND, 22 (11.6%) had a positive dissection. Between 1 and 51 nodes (median 9) were removed per dissection. PSA, clinical stage, Gleason score and SVB results all significantly influenced node findings. Positive nodes were encountered in 26.5% of those with a PSA > 20 ng/mL (p=0.0002), in 16.4% with stage T2b-T3a (p = 0.003), in 20% with Gleason scores 7-10 (p = 0.0006) and in 38% of men with a positive SVB (p < 0.0001). Logistic regression analysis with PSA, Gleason score, clinical stage and the results of the SVB demonstrated that a positive SVB was the most significant predictor of node positivity. The overall transfusion rate was 1% (2/189) and median hospital stay was one day. The complication rate for the LPLND was 9% (17/189). Conclusion: The LPLND is an effective and efficient means of detecting positive pelvic lymph nodes in patients with localized prostate cancer. It should be considered a necessary diagnostic modality in all appropriate patients who may be candidates for curative therapy.