Does topography of cancer in the prostate correlate to risk for positive lymph nodes?

An interesting new report from the research team at Memorial Sloan-Kettering Cancer Center has explored the relationship between the patterns of occurrence of positive lymph nodes (LNs) and the topography of the cancer in the prostate and the seminal vesicles.

To carry out this study, Tokuda et al. reviewed original pathology slides from 125 men who underwent a radical prostatectomy and who were found to have LN-positive disease.

They were able to show the following:

  • The average numbers of LNs surgically removed per patient were a mean of 14.6 and a median of 13.
  • The numbers of positive lymph nodes identified were
    • A single positive LN in 76/125 patients (61 percent)
    • Two positive LNs in 33/125 patients (26 percent)
    • Three or more positive LNs in 16/125 patients (13 percent).
  • 58, 44, and 20 patients had LN metastasis on the right side, on the left side , and on both sides, respectively.
  • 108/125 patients (86 percent) exhibited extraprostatic extension.
  • 46/125 patients (37 percent) exhibited seminal vesicle invasion
  • 64 percent of the cases exhibited lymphovascular invasion.
  • Mean and median total tumor volumes were 6.39 and 3.92 cm3.
  • At least 50 percent of tumor was Gleason pattern  4 or 5 in 105/125 specimens (84 percent).
  • At least 90 percent of tumor was Gleason pattern  4 or 5 in 73/125 specimens (58 percent).
  • The dominant lesions were identified in the right lobe of 50 cases, in the left lobe of 44 cases, and bilaterally in 31 cases.
  • 15/50 right-lobe-dominant tumors (30 percent) and 18/44 left-lobe-dominant tumors  (41 percent)  had LN metastasis on the contralateral (opposite) side.
  • Only 5/125 patients with LN metastasis (4 percent) had anterior dominant tumors.

The authors conclude that, in their patient series, “LN metastasis is overwhelmingly associated with high-grade, high-stage, and large volume disease” and that “LN positivity is rarely associated with anterior dominant tumors.”

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