Objectives: Traditionally anterior prostatic fat (APF) hasn't been included in pelvic lymph node (LN) dissection templates following radical prostatectomy. In this study we evaluate the incidence of lymphoid tissue in the APF and the incidence of LN metastasis in APF in patients who have undergone robotic-assisted laparoscopic radical prostatectomy (RALP). Methods: A prospective database of RALP has been maintained between January 2010 and September 2015. APF is routinely excised and sent separately for histopathological evaluation to identify lymphoid tissue and metastatic prostate cancer. Results: A total of 629 underwent RALP. Forty-six (7.3%) of the patients had lymphoid tissue on histopathological evaluation. Two patients had meta-static disease. Both patients with positive LNs were intermediate risk on pre-operative evolution (A-PSA 16.6 ng/ml, Gleason 3 + 4; B PSA 7.3 ng/ml, Gleason 4 + 3) and upgraded on final prostate pathological evaluation to high risk disease (A-Gleason 4 + 5, pT3b, B-Gleason 4 + 3, pT4). Conclusion: There appears to be lymphatic drainage to the APF from the prostate. Hence APF should be included in pelvic LN dissection templates when lymphadenectomy is contemplated in patients undergoing radical prostatectomy.

Keywords:
Anterior prostatic fat, Radical prostatectomy, Prostate cancer
1.
Bianco FJ Jr, Scardino PT, Eastham JA: Radical prostatectomy: long-term cancer control and recovery of sexual and urinary function (“trifecta”). Urology 2005;66(5 Suppl):83-94.
2.
Gandaglia G, Sammon JD, Chang SL, Choueiri TK, Hu JC, Karakiewicz PI, Kibel AS, Kim SP, Konijeti R, Montorsi F, Nguyen PL, Sukumar S, Menon M, Sun M, Trinh QD: Comparative effectiveness of robot-assisted and open radical prostatectomy in the post-dissemination era. J Clin Oncol 2014;32:1419-1426.
3.
Burkhard FC, Schumacher M, Studer UE: The role of lymphadenectomy in prostate cancer. Nat Clin Pract Urol 2005;2:336-342.
4.
Ploussard G, Briganti A, de la Taille A, Haese A, Heidenreich A, Menon M, Sulser T, Tewari AK, Eastham JA: Pelvic lymph node dissection during robot-assisted radical pros tatectomy: efficacy, limitations, and complications-a systematic review of the literature. Eur Urol 2014;65:7-16.
5.
Ahlering TE, Eichel L, Edwards RA, Lee DI, Skarecky DW: Robotic radical prostatectomy: a technique to reduce pT2 positive margins. Urology 2004;64:1224-1228.
6.
Aning JJ, Thurairaja R, Gillatt DA, Koupparis AJ, Rowe EW, Oxley J: Pathological analysis of lymph nodes in anterior prostatic fat excised at robot-assisted radical prostatectomy. J Clin Pathol 2014;67:787-791.
7.
Jeong J, Choi E Y, Kang DI, Ercolani M, Lee DH, Kim WJ, Kim IY: Pathologic implications of prostatic anterior fat pad. Urol Oncol 2013;31:63-67.
8.
Finley DS, Deane L, Rodriguez E, Vallone J, Deshmukh S, Skarecky D, Carpenter P, Narula N, Ornstein DK, Ahlering TE: Anatomic excision of anterior prostatic fat at radical prostatectomy: implications for pathologic upstaging. Urology 2007;70:1000-1003.
9.
Yuh B, Wu H, Ruel N, Wilson T: Analysis of regional lymph nodes in periprostatic fat following robotassisted radical prostatectomy. BJU Int 2012;109:603-607.
10.
Kim IY, Modi PK, Sadimin E, Ha YS, Kim JH, Skarecky D, Cha DY, Wambi CO, Ou YC, Yuh B, Park S, Llukani E, Albala DM, Wilson T, Ahlering T, Badani K, Ahn H, Lee DI, May M, Kim WJ, Lee DH: Detailed analysis of patients with metastasis to the prostatic anterior fat pad lymph nodes: a multi-institutional study. J Urol 2013;190:527-534.
11.
Atmaca AF, Canda AE, Keske M, Arslan ME, Kamaci D, Alkan E, Balbay MD: Does anterior prostatic fat tissue removed during robotic radical prostatectomy contain any lymph nodes? Cent European J Urol 2015; 68:410-414.
12.
Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, Mason M, Matveev V, Wiegel T, Zattoni F, Mottet N: EAU guidelines on prostate cancer. European Association of Urology; 2014.
13.
National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology 2012. Prostate Cancer.
14.
Thompson I, Thrasher JB, Aus G, Burnett AL, Canby-Hagino ED, Cookson MS, D'Amico AV, Dmochowski RR, Eton DT, Forman JD, Goldenberg SL, Hernandez J, Higano CS, Kraus SR, Moul JW, Tangen CM: Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol 2007;177:2106-2131.
15.
Gervasi LA, Mata J, Easley JD, Wilbanks JH, Seale-Hawkins C, Carlton CE, Jr, Scardino PT: Prognostic significance of lymph nodal metastases in prostate cancer. J Urol 1989; 142:332-336.
16.
Hansen J, Budäus L, Spethmann J, Schlomm T, Salomon G, Rink M, Haese A, Steuber T, Heinzer H, Huland H, Graefen M, Michl U: Assessment of rates of lymph nodes and lymph node metastases in periprostatic fat pads in a consecutive cohort treated with retropubic radical prostatectomy. Urology 2012;80:877-882.
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2017
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