Objectives: Retrospective studies have shown that pelvic lymph node dissection can be dispensed with in selected men undergoing radical prostatectomy. We prospectively evaluated the influence of nondissection of pelvic lymph nodes on tumor progression in our first 100 perineal prostatectomies. Methods: From October 1992 to February 1998, 100 patients underwent radical perineal prostatectomy for localized prostate cancer. Preoperative PSA, the Gleason score of positive biopsies and age at surgery were noted. Forty–three of the 100 patients (group 1) did not undergo pelvic lymph node dissection because their preoperative PSA level was below 10 ng/ml (Hybritech assay, normal value 4 ng/ml) and the Gleason score of their positive biopsies was below 7. These 43 patients were compared with 25 of the 114 patients operated on during the same period by the retropubic approach and who had pelvic node dissection and the same preoperative criteria (PSA <10 ng/ml and a Gleason score of positive biopsies <7; group 2). All prostatectomy specimens were processed according to the Stanford protocol: prostate weight, Gleason score, capsular, seminal vesicle, lymph node and surgical margin status, and tumor volume were studied. Postoperative followup was based on routine serum PSA assays after 1 and 3 months and then half–yearly. Biological progression was defined as PSA level which was detectable postoperatively (≧0.2 ng/ml). Kaplan–Meier analysis was used to evaluate the likelihood of biochemical recurrence. Results were compared by using Fisher’s test, the Mann–Whitney test and the log–rank test. Differences were considered significant when the p value was <0.05. Results: No differences in preoperative characteristics were observed; in groups 1 and 2, mean age was 65.9 and 64.7 years, PSA was 6.7 and 5.11 ng/ml, and the Gleason biopsy score was 5.7 vs. 5.0, respectively. In groups 1 and 2, specimen weight was 44.5 and 54.3 g (p = 0.04), the Gleason score was 6.2 and 5.6, tumor volume was 0.91 and 0.8 ml, 81.4 and 84% of patients were in stage pT2, 13.9 and 12% had extracapsular disease, 4.6 and 0% had seminal vesicle invasion, and 13.9 and 16% had positive surgical margins, respectively. The mean follow–up was 2.74 years (0.27–5.59 years). The actuarial 5–year recurrence–free rate was 78% in group 1 and 80% in group 2 (p>0.05). Conclusion: The lack of pelvic lymph node dissection does not influence the intermediate term results of perineal radical prostatectomy in selected patients (preoperative PSA <10 ng/ml and Gleason score for positive biopsies <7).

Keywords:
Prostate cancer, Radical prostatectomy, Perineal approach, Lymphadenectomy
1.
Walsh PC, Lepor H, Eggleston JD: Radical prostatectomy with preservation of sexual function: Anatomical and pathological considerations. Prostate 1983;4:473–485.
2.
Young HH: The early diagnosis and radical cure of carcinoma of the prostate: Being a study of 40 cases and presentation of a radical operation which was carried out in four cases. Bull Johns Hopkins Hosp 1905;16:315.
3.
Parra RO, Boullier JA, Rauscher JA, Cummings JM: The value of laparoscopic lymphadenectomy in conjunction with radical perineal or retropubic prostatectomy. J Urol 1994; 151:1599–1602.
4.
Teichman JM, Reddy PK, Hulbert JC: Laparoscopic pelvic lymph node dissection, laparoscopically assisted seminal vesicle mobilization, and total perineal prostatectomy versus radical retropubic prostatectomy for prostate cancer. Urology 1995;5:823–830.
5.
Bluestein DL, Bostwick DG, Bergstralh EJ, Oesterling JE: Eliminating the need for bilateral pelvic lymphadenectomy in select patients with prostate cancer. J Urol 1994;151:1315–1320.
6.
Bangma CH, Hop WC, Schröder FH: Eliminating the need for pre–operative frozen section analysis of pelvic lymph nodes during radical prostatectomy. Br J Urol 1995;76:595–599.
7.
Narayan P, Fournier G, Gajendran V, Leidich R, Lo R, Wolf JS, Jacob G, Nicolaisen G, Palmer K, Freiha F: Utility of preoperative serum prostate–specific antigen concentration and biopsy Gleason score in predicting risk of pelvic lymph node metastases in prostate cancer. Urology 1994;44:519–524.
8.
Bishoff JT, Reyes A, Thompson IM, Harris MJ, St Clair SR, Gomella L, Butzin CA: Pelvic lymphadenectomy can be omitted in selected patients with carcinoma of the prostate: Development of a system of patient selection. Urology 1995;45:270–274.
9.
Stamey TA, McNeal JE, Freiha FS, Redwine E: Morphometric and clinical studies on 68 consecutive radical prostatectomies. J Urol 1988; 139:1235–1241.
10.
International Union Against Cancer: TNM Classification of Malignant Tumors; in Sobin LH, Wittekind C (eds): ed 5. New York, Wiley–Liss, 1997, pp 170–173.
11.
Pound CR, Partin AW, Epstein JI, Walsh PC: Prostate–specific antigen after anatomic radical retropubic prostatectomy. Urol Clin North Am 1997;24:395–406.
12.
Boccon–Gibod L, Ravery V, Vordos D, Toublanc M, Delmas V, Boccon–Gibod L: Radical prostatectomy for prostate cancer: Perineal approach increases risk of surgically induced positive margins and capsular incisions. J Urol 1998;160:1383–1385.
13.
Weldon VE: Response: Radical prostatectomy for prostate cancer: The perineal approach increases the risk of surgically induced positive margins and capsular incision. J Urol 1999; 161:1287.
14.
Doublet JD, Lagrange L, Ciofu C, Thibault P, Gattegno B: Prostatectomie radicale: Comparaison de la voie périnéale et de la voie rétropubienne (40 patients). Résultats préliminaires. Prog Urol 1994;4:33–39.
15.
Frazier HA, Robertson JE, Paulson DF: Radical prostatectomy: The pros and cons of the perineal versus retropubic approach. J Urol 1992;147:888–890.
16.
Haab F, Boccon–Gibod L, Delmas V, Boccon–Gibod L, Toublanc M: Perineal versus retropubic radical prostatectomy for T1, T2 prostate cancer. Br J Urol 1994;74:626–629.
17.
Salomon L, Colombel M, Patard JJ, Contremoulin I, Bellot J, Lefrere–Belda MA, Gasman D, Chopin D, Abbou CC: Voies rétropubiennes et périnéales: Plaidoyer pour la prostatectomie radicale par voie périnéale. Prog Urol 1997;7:976–983.
18.
Kahn SA, Tewari A, Narayan P: Radical perineal prostatectomy versus radical retropubic prostatectomy: A clinical comparison. J Urol 1998;159:61.
19.
Lance RS, Thraher JB, Friedrichs PA, Kane C, Powell CR, Moul JW: Comparison of radical perineal prostatectomy to radical retropubic prostatectomy for clinically localized prostate cancer: Uniformed Services Urology Research Group (USURG) experience. J Urol 1998;159: 253.
20.
Fowler JE Jr, Whitmore WF Jr: The incidence and extent of pelvic lymph node metastases in apparently localized prostate cancer. Cancer 1981;47:2941–2945.
21.
Zincke H, Farrow GM, Myers RP, Benson RC, Furlow WL, Utz DC: Relationship between grade and stage of adenocarcinoma of the prostate and regional pelvic lymph node metastases. J Urol 1982;128:498–501.
22.
Danella JF, deKernion JB, Smith RB, Steckel J: The contemporary incidence of lymph node metastases in prostate cancer: Implications for laparoscopic lymph node dissection. J Urol 1993;149:1488–1491.
23.
Petros JA, Catalona WJ: Lower incidence of unsuspected lymph node metastases in 521 consecutive patients with clinically localized prostate cancer. J Urol 1992;147:1574–1575.
24.
McNeal JE, Villers AA, Redwine EA, Freiha FS, Stamey TA: Histologic differentiation, cancer volume, and pelvic lymph node metastasis in adenocarcinoma of the prostate. Cancer 1990;66:1225–1233.
25.
Whitmore WF Jr: Proceedings: The natural history of prostatic cancer. Cancer 1973;32: 1104–1112.
2000
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