Anatomic Excision Of Anterior Prostatic Fat At Radical Prostatectomy: Implications For Pathologic Upstaging
Between 2006 and 2007, 204 patients undergoing robotic-assisted laparoscopic radical prostatectomy by 2 surgeons had the APF removed, and the technique of the dissection reviewed on video. A total of 30 of these 204 men had lymph nodes found in the APF (14.7%). The number of lymph nodes ranged from 1-3 with an average of 1.4. The average lymph node size was 6 to 7mm. Four of the 204 men were found to have metastatic CaP in the lymph nodes of the APF. Three of these 4 men had Gleason score of 7 or greater. All of these 4 men had CaP in the anterior prostate and 3 of them had a focally positive surgical margin. In 2 of the 4 patients, metastatic CaP was identified in the posteriorly located periprostatic lymph nodes. The only variable that separated the men with APF lymph nodes from those without was a greater body mass index (29kg/m2 vs. 26.7729kg/m2).
The video analysis demonstrated that the fat overlying the anterior prostate extends back to the bladder neck and lateral to the obturator lymph node chain. The implication is that for a few patients undergoing radical prostatectomy, CaP in the anterior prostate combined with a greater body mass index puts the patients at risk for metastasis to the APF lymph nodes.
Finley DS, Deane L, Rodriguez E, Vallone J, Deshmukh S, Skarecky D, Carpenter P, Narula N, Ornstein DK, Ahlering' TE
Urology. 70(5): 1000-1003, November 2007
doi:10.1016/j.urology.2007.09.028
Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D
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Anatomice excizia anterior Prostatic Fat La Radical prostatectomia: implicaþii pentru patologic Upstaging - Anatomic Excision Of Anterior Prostatic Fat At Radical Prostatectomy: Implications For Pathologic Upstaging - articole medicale engleza - startsanatate