Clinical Factors Predicting Bilateral Lymph Node Invasion in High-Risk Prostate Cancer

Porcaro, Antonio Benito; Luyk, Nicolò De; Corsi, Paolo; Sebben, Marco; Tafuri, Alessandro; Processali, Tania; Mattevi, Daniele; Pirozzi, Marco; Cerruto, Maria Angela; Amigoni, Nelia; Rizzetto, Riccardo; Brunelli, Matteo; Migliorini, Filippo; Siracusano, Salvatore; Artibani, Walter

doi:10.1159/000476039

Cited by 15 publications

(12 citation statements)

References 19 publications

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“…Indeed, the current definition of locally advanced PC includes any patient with positive LNs, regardless of the actual ex- tent of the tumor in the prostatic gland. Recently, high PSA was detected as an independent predictor for LNs invasion in high-risk patients [21] . This clinical variability between patients adds more challenge to the identification of a clear evidence-based approach for the management of these patients.…”

Section: Discussionmentioning

confidence: 99%

The Role of Radical Prostatectomy and Radiotherapy in Treatment of Locally Advanced Prostate Cancer: A Systematic Review and Meta-Analysis

et al. 2017

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Background: The role of radical prostatectomy (RP) is still controversial for locally advanced prostate cancer (PC). Radiotherapy (RT) and hormonal therapy (HT) are usually used as a primary treatment. Material and Methods: A systematic online search was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Eligible publications reporting the overall survival (OS) and/or disease-specific survival (DSS) were included. A total of 14 studies, including 17,869 patients, were considered for analysis. The impact of therapeutic modalities on survival was assessed, with a risk of bias assessment according to the Newcastle Ottawa Scale. Results: For RP, RT, and HT, the mean 10-year OS was 70.7% (95% CI 61.3-80.2), 65.8% (95% CI 48.1-83.3), and 22.6% (95% CI 4.9-40.3; p = 0.001), respectively. The corresponding 10-year DSS was 84.1% (95% CI 75.1-93.2), 89.4% (95% CI 70.1-108.6), and 50.4% (95% CI 31.2-69.6; p = 0.0127), respectively. Among all treatment combinations, RP displayed significant improvement in OS when included in the treatment (Z = 4.01; p < 0.001). Adjuvant RT significantly improved DSS (Z = 2.7; p = 0.007). Combination of RT and HT favored better OS in comparison to monotherapy with RT or HT (Z = 3.61; p < 0.001). Conclusion: Improved outcomes in advanced PC were detected for RP plus adjuvant RT vs. RP alone and RT plus adjuvant HT vs. RT alone with comparable survival results between both regimens. RP with adjuvant RT may present the modality of choice when HT is contraindicated.

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Section: Discussionmentioning

confidence: 99%

The Role of Radical Prostatectomy and Radiotherapy in Treatment of Locally Advanced Prostate Cancer: A Systematic Review and Meta-Analysis

et al. 2017

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“…Indeed, we previously demonstrated that extensive tumor load at the time of biopsy is a strong predictor of more aggressive PCA in terms of tumor upgrading and upstaging as well as unilateral or bilateral lymph node metastasis and seminal vesical invasion. 31–34 Also, we previously found that the number of positive cores can predict tumor upgrading in patients under active surveillance. 35 In this context, PVI, with other clinical parameters, including PSA, DRE and age, should be included in the risk calculator used in the management of patients in which the indication to perform a baseline prostate biopsy is unclear as well as in the prediction of tumor load that is closely related to PCA aggressiveness.…”

Section: Discussionmentioning

confidence: 99%

Prostate volume index and prostatic chronic inflammation have an effect on tumor load at baseline random biopsies in patients with normal DRE and PSA values less than 10 ng/ml: results of 564 consecutive cases

Porcaro

Tafuri

Sebben

et al. 2019

Therapeutic Advances in Urology

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Background: To assess the association of prostate volume index (PVI), defined as the ratio of the central transition zone volume (CTZV) to the peripheral zone volume (PZV), and prostatic chronic inflammation (PCI) as predictors of prostate cancer (PCA) load in patients presenting with normal digital rectal exam (DRE) and prostate-specific antigen (PSA) ⩽ 10 ng/ml at baseline random biopsies. Methods: Parameters evaluated included age, PSA, total prostate volume (TPV), PSA density (PSAD), PVI and PCI. All patients underwent 14 core transperineal randomized biopsies. We considered small and high PCA load patients with no more than three (limited tumor load) and greater than three (extensive tumor load) positive biopsy cores, respectively. The association of factors with the risk of PCA was evaluated by logistic regression analysis, utilizing different multivariate models. Results: 564 Caucasian patients were included. PCA and PCI were detected in 242 (42.9%) and 129 (22.9%) cases, respectively. On multivariate analysis, PVI and PCI were independent predictors of the risk of detecting limited or extensive tumor load. The risk of detecting extensive tumor load at baseline biopsies was increased by PSAD above the median and third quartile as well as PVI ⩽ 1 [odds ratio (OR)=1.971] but decreased by PCI (OR=0.185; 95% CI: 0.088–0.388). Conclusions: Higher PVI and the presence of PCI predicted decreased PCA risk in patients presenting with normal DRE, and a PSA ⩽ 10 ng/ml at baseline random biopsy. In this subset of patients, a PVI ⩽ or >1 is able to differentiate patients with PCA or PCI.

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“…Considering the small sample on patients presenting lymph node involvement in Marcille's fossa, to perform a multivariable analysis was not possible. Moreover, we previously reported our analysis on the clinical predictors of LN invasion in low-, intermediate-and high-risk PCa patients who underwent ePLND [17,34]. 2 (8) 1 ( Aggressiveness of tumour biology associates with multiple LN metastases.…”

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confidence: 99%

Lymph Nodes Invasion of Marcille’s Fossa Associates with High Metastatic Load in Prostate Cancer Patients Undergoing Extended Pelvic Lymph Node Dissection: The Role of “Marcillectomy”

et al. 2019

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Introduction: To assess the incidence of malignancy involvement of lymph nodes (LNs) in Marcille’s fossa in patients undergoing robot assisted radical prostatectomy (RARP) and extended pelvic lymph nodes dissection (ePLND) for prostate cancer (PCa). Design, Setting, and Participants: Between January 2014 and December 2017, details of patients who underwent RARP and ePLND were prospectively analysed. All the nodal packets were dissected separately, grouped into left and right nodes and submitted in separate packages to dedicated pathologist. Results and Limitations: Two hundred and twenty-one patients underwent ePLND and RARP in the study period. In aggregate, Marcille’s LNs involvement was found in 5 (2.3%) of patients, 2 on the left side and 3 on the right side. Per cent of positive cores and Gleason at biopsy are clinical predictors of LNs invasion; moreover, in the surgical specimen, seminal vesicle invasion and high-grade cancer were factors related to loco-regional metastases. Conclusions: Marcille’s nodes involvement is associated to contemporarily multiple LN metastases in other template locations in high-risk PCa patients. The Marcille’s lymphadenectomy would be recommended when planning an ePLND in high-risk PCa.

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Clinical Factors Predicting Bilateral Lymph Node Invasion in High-Risk Prostate Cancer

Cited by 15 publications

References 19 publications

The Role of Radical Prostatectomy and Radiotherapy in Treatment of Locally Advanced Prostate Cancer: A Systematic Review and Meta-Analysis

The Role of Radical Prostatectomy and Radiotherapy in Treatment of Locally Advanced Prostate Cancer: A Systematic Review and Meta-Analysis

Prostate volume index and prostatic chronic inflammation have an effect on tumor load at baseline random biopsies in patients with normal DRE and PSA values less than 10 ng/ml: results of 564 consecutive cases

Lymph Nodes Invasion of Marcille’s Fossa Associates with High Metastatic Load in Prostate Cancer Patients Undergoing Extended Pelvic Lymph Node Dissection: The Role of “Marcillectomy”

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