Incidence, location, and significance of periprostatic and periseminal vesicle lymph nodes in prostate cancer Journal Article
| Authors: | Kothari, P. S.; Scardino, P. T.; Ohori, M.; Kattan, M. W.; Wheeler, T. M. |
| Article Title: | Incidence, location, and significance of periprostatic and periseminal vesicle lymph nodes in prostate cancer |
| Abstract: | Pelvic lymph node metastases in prostate cancer (PCa) carry an ominous prognosis. Periprostatic/periseminal vesicle (PP/PSV) lymph nodes are present in some individuals, but their incidence and involvement by metastases are unknown. A total of 832 of 1233 (67.5%) patients who underwent radical retropubic prostatectomy for clinically localized PCa at the Methodist Hospital from 1983 to 1998 by one surgeon (P.T.S.) had whole-mount slides available for review. Of these, 92 (11.1%) had received preoperative therapy (radiation in 48 [5.8%], hormonal in 44 [5.3%]). Slides were examined with the naked eye by placing them on a white illuminated background, and any area suggestive of a lymph node in PP/PSV fat was confirmed microscopically and assessed for the presence of metastases. Thirty-seven of 832 patients (4.4%) had 39 PP/PSV lymph nodes - one bilateral, one with two ipsilateral lymph nodes, and the rest solitary. Sizes ranged from 0.7 to 4.5 mm (mean 1.8 mm). Distribution was 2 of 39 (5.1%) apical, 3 of 39 (7.7%) mid, 17 of 39 (43.6%) base, and 17 of 39 (43.6%) seminal vesicle. Five patients (0.6%) had metastatic PCa to the PP/PSV lymph nodes. All five patients were of advanced pathologic T stage [one pT3a (extraprostatic extension) and four pT3b (seminal vesicle invasion)]. Only two of those five (40%) had metastases (all ipsilateral) to pelvic lymph nodes. In three of five (60%) the metastases were isolated to the PP/PSV lymph nodes. Metastases were to the lymph nodes in the periseminal vesicle fat in four of five (80%) of the cases and in the fat surrounding the base of the prostate in one of five (20%). Four of five (80%) patients recurred. Histologic grade (Gleason score), tumor volume, and failure (recurrence) rates were significantly different between the five patients with metastases and the 32 patients without metastases to the PP/PSV lymph nodes (p <0.0001, p <0.0001, and p = 0.005, respectively). However, there was no evidence that an individual patient's probability of having a PP/PSV lymph node increased with resection of the neurovascular bundle (p = 0.7698). PP/PSV lymph nodes are uncommon, but based upon these limited data, it appears that patients with metastases limited to PP/PSV lymph nodes have a poor prognosis (similar to pelvic lymph node metastases) and should be included in the American Joint Committee on Cancer (AJCC) Staging Manual to indicate "N1" if positive for metastases. |
| Keywords: | adult; clinical article; controlled study; aged; middle aged; histopathology; combined modality therapy; follow-up studies; lymph node metastasis; lymph nodes; lymphatic metastasis; adenocarcinoma; tumor localization; metastasis; neoplasm recurrence, local; tumor volume; prostate cancer; prostatic neoplasms; prostate; prostatectomy; tumor recurrence; lymph node; scoring system; seminal vesicle; seminal vesicles; humans; prognosis; human; male; article; periprostatic/periseminal vesicle |
| Journal Title: | American Journal of Surgical Pathology |
| Volume: | 25 |
| Issue: | 11 |
| ISSN: | 0147-5185 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2001-11-01 |
| Start Page: | 1429 |
| End Page: | 1432 |
| Language: | English |
| DOI: | 10.1097/00000478-200111000-00012 |
| PUBMED: | 11684961 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Export Date: 21 May 2015 -- Source: Scopus |
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