Predictive value of the anatomical location of ultrasound-guided systematic sextant prostate biopsies for the nodal status of patients with localized prostate cancer.
OBJECTIVE: The aim of this study was to determine the predictive value of the anatomical location of positive prostate biopsies for the nodal status of patients with localized prostate cancer. METHODS: A total of 130 patients were included in this analysis. Prior to surgery, all patients underwent digital rectal examination (DRE), prostate-specific antigen (PSA) analysis and transrectal ultrasonography with systematic sextant biopsies. Each biopsy core was analyzed separately. Subsequently, all patients underwent pelvic lymphadenectomy and radical retropubic prostatectomy. The final pathological stage was correlated with the number of anatomical location of positive prostate biopsies. RESULTS: Eighteen patients (13.8%) had positive lymph nodes. Based on clinical stage, serum PSA and the anatomical location of positive prostate biopsies, a staging model was developed with particular emphasis on the nodal status. In group I (n = 33; 25.4%), defined by negative basal biopsies and clinical stage T2 (irrespective of PSA), all patients had negative lymph nodes. Similarly, all but 1 patient were lymph node negative in group II (n = 36; 27.7%), which included cases of positive basal biopsy, PSA < 10 ng/ml clinical T2. Finally, group III (n = 61; 46.9%), defined by a positive basal biopsy and/or PSA > 10 ng/ml and/or clinical T3 included 17/18 (94.4%) node-positive patients. CONCLUSION: Based on these data we consider it safe not to perform lymphadenectomy in group I and group II patients as only 1/69 patients (1.4%) was node positive. Patients meeting the group III criteria, however, should undergo pelvic lymphadenectomy, as 94.5% of all lymph-node-positive cases were in this group.