INTRODUCTION AND OBJECTIVE:
AUA guidelines for localized prostate cancer (PCa) states that pelvic lymph node dissection (PLND) is indicated for patients with unfavorable intermediate and high-risk disease and should be considered in favorable intermediate risk patients. NCCN guidelines recommend PLND when risk for nodal disease is ≥2%. Given the discrepancy in recommendations, we sought to assess which patients with intermediate risk PCa would benefit from a PLND across the Michigan Urological Surgery Improvement Collaborative.
Data regarding all robot-assisted radical prostatectomy (RARP) (03/2012-10/2020) were prospectively collected, including patient and surgeon characteristics.
Among 8,664 men undergoing RARP for intermediate-risk PCa, 80.2% were performed with PLND (n = 6951), of which 3.0% were LN+ (n=207). According to the current AUA risk stratification system, 1.2% of favorable intermediate risk PCa and 4.9% of unfavorable intermediate risk PCa were positive for lymph node metastases (LN+). There were also differences in the LN+ rates among the subgroups of each of these categories (0.0% - 1.3%), and (3.7% – 5.2%). Additional factors, not accounted for in this system, that were associated with higher LN+ rates include ≥3 cores involved, ≥35% involvement at any core, and unfavorable genomic classifier result.
When to perform PLND remains up for debate. Our data suggest patients with favorable intermediate risk prostate cancer should only undergo PLND if they have ≥3 cores involved, ≥35% involvement at any core, and/or unfavorable genomic classifier result.
Source of Funding:
The corresponding author would like to thank the Betz Family Endowment for Cancer Research for their continued support. Funding was provided to B.R. Lane in part by the Spectrum Health Foundation (RG0813-1036). The authors would like to acknowledge the support provided the Value Partnerships program at Blue Cross Blue Shield of Michigan