The Role of Periprostatic and Periseminal Vesicle Lymph Node Metastasis in the Staging and Prognosis of Prostate Cancer.
M Kristina Subik, Jorge L Yao, P Anthony di Sant'Agnese, Hiroshi Miyamoto. University of Rochester, NY
Background: Pelvic lymph node (LN) metastases in prostate cancer (PC) are associated with a poor prognosis. Periprostatic (PP)/periseminal vesicle (PSV) LNs are occasionally found in radical prostatectomy (RP) specimens, but the significance of their involvement by PC metastases is poorly understood.
Design: We searched the Surgical Pathology database of our institution from August of 2002 to June of 2010 and identified 33 RP cases (age range: 51-70 years; mean: 62.8 years) where PP/PSV LNs had been assessed.
Results: Of the 33 patients, 20 (60.6%) had a single PP/PSV LN, whereas 13 (39.4%) had multiple (up to 8) LNs. Their size ranged from 0.1 to 1.8 cm (mean: 0.47 cm). The location was determined in 27 LNs: 11 (40.7%) on the right and 16 (59.3%) on the left; and 2 (7.4%) at apex, 6 (22.2%) at mid, 12 (44.4%) at base, and 7 (25.9%) at SV. Of the 20 PP LNs, 16 (80.0%) were located posteriorly, the remaining 4 (20.0%) were anteriorly, and none were laterally. Six of 33 (18.2%) patients had metastasis to the PP/PSV LNs. All of these were involved by metastasis, but not by contiguous extension of the tumors. Two of these 6 cases additionally had metastases to the pelvic LNs. Another patient had a metastasis in a pelvic LN, but not in PP/PSV LNs. The 6 LNs with metastasis included 4 PP (2 at posterior apex; 2 at posterior base) and 2 PSV. The maximal size of the metastatic tumor in each PP/PSV LN ranged from 0.05 to 1.0 cm (mean: 0.29 cm). All the patients with PP/PSV LN metastasis, except one [pT2c/Gleason score (GS) 7], were of advanced pathologic stage with a grade of GS7 or higher (1 pT3a; 5 pT3b). Despite undergoing adjuvant radiotherapy, one of the 4 cases with limited PP/PSV LN metastasis was radiologically found to develop pelvic LN metastasis 11 months after RP. In contrast, 27 cases without PP/PSV LN involvement were of lower grades (12 GS6; 14 GS7; 1 GS8) (p=0.0648) and stages (19 pT2; 5 pT3a; 3 pT3b) (p=0.0248), and none of them developed biochemical/clinical recurrences with a mean follow-up of 12.8 months.
Conclusions: PP/PSV LNs were uncommon, but isolated PC metastasis to these LNs could occur. PP/PSV LN metastases correlated with advanced disease. Further studies including larger patient cohorts with longer follow-up are necessary to validate the current findings. However, PCs with metastases limited to PP/PSV LNs may need to be staged as "N1". In addition, the potential difficulty of grossly identifying the PP/PSV LNs, even in the presence of metastasis, suggests the importance of thorough histological examination of RP specimens.
Category: Genitourinary (including renal tumors)
Monday, February 28, 2011 1:00 PM
Poster Session II # 127, Monday Afternoon