Risk factors for the development of distant metastases in patients undergoing pelvic lymphadenectomy for prostatic cancer.
Sixty-two patients with clinically localised prostatic cancer underwent pelvic lymphadenectomy between 1972 and 1975. Thirty-one patients had concomitant total prostatectomy. The objectives of this study included determination of the relation of findings at lymphadenectomy, with and without total prostatectomy, to subsequent clinical course, identification of histologic parameters related to the subsequent appearance of distant metastatic disease, and determination of the vital status of patients initially having a staging pelvic lymphadenectomy. Follow-up of at least 5 years was obtained for 52 patients, including 28 who had concomitant total prostatectomy. Ten patients were lost to follow-up. Fifty-four percent are alive with metastatic disease 10 percent have died with metastatic disease, 10 percent have died with metastatic cancer, and 12 percent have died without prostate cancer. Metastases have developed in 11 (37 percent) of 30 patients with negative pelvic lymph nodes, reflecting either seminal vesicle or transcapsular invasion. Minimal lymph node involvement (one or two pelvic nodes) alone may not be as poor a prognostic sign as originally thought. Metastases have developed in 22 percent of nine patients with tumor considered stage B2. No recurrences or metastases were noted in the seven patients with stage B1 disease. Patients with high grade lesions were at no increased risk for distant metastases, although they constituted a relatively small segment of our series. Thus the extent of local disease correlates with the subsequent development of distant metastasis. Adjuvant systemic treatment (endocrine manipulation, chemotherapy, or both) has a rational basis in patients with one or more of these identifiable risk factors.