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AUA 2019

AUA 2019: Assessing The Risk of Lymph Node Invasion with the New 2014 International Society of Urological Pathology Classification in Patients with Prostate Cancer Treated with Robotic Radical Prostatectomy and Lymph Node Dissection

Chicago, IL (UroToday.com) During the poster session on Moderated Poster 9 - Prostate Cancer: Staging I at the Annual AUA 2019 meeting in Chicago, IL, Dr. De Nunzio presented his moderated poster on Assessing the risk of lymph node invasion with the new 2014 International Society of Urological Pathology classification in patients with prostate cancer treated with robotic radical prostatectomy and lymph node dissection: a novel nomogram. The Briganti nomogram, since its publication, has been widely adopted worldwide to predict the risk lymph node invasion in patients undergoing radical prostatectomy. However, the Briganti nomogram does not include the new 2014 International Society of Urological Pathology (ISUP) grading, and it is not related to a robotic radical prostatectomy series. Dr. De Nunzio and colleagues aimed to develop a novel clinical nomogram using the new ISUP 2014 grades to predict lymph node invasion, in patients undergoing robotic radical prostatectomy for prostate cancer

Between 2012 and 2017, a consecutive series of patients with prostate cancer were treated with robotic radical prostatectomy and lymph node dissection in a single center. Demographic, clinical and histological characteristics of the patients were recorded. Histological specimens were graded according to the new 2014 ISUP classification. A Nomogram was generated based on the logistic regression model used to predict lymph-node invasion
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Dr. De Nunzio then summarized the results. Overall 7769 patients were enrolled with a median of 12 (8/16) lymph nodes removed. Median age was 65 (60/70) years, median BMI was 27 (25/29) kg/m2, median prostate volume was 38 (29/50) ml, and median PSA was 7.4 (5.5/11) ng/ml. Advanced clinical stage (T3a or greater) was present in 126 /7769 (1.6%) of the patients. On RRP 3068/7769 (40%) presented high grade disease (ISUP 2014 ≥3), 3145/7769 (19%) presented high stage disease (≥T3a) and 680/7769 (9%) presented positive lymph nodes. On multivariate analysis clinical stage (OR=2.85; 95%CI:1.87-4.35, p=0.001), PSA density (OR=1.65, 95%CI: 1.38-1.97, p=0.001), percentage of positive cores (OR=1.02; 95%CI:1.02-1.03; p=0.001) and ISUP 2014 grade (OR=1.93; 95%CI:1.80-4.35, p=0.001) were independent predictors of positive lymph nodes,

Dr. De Nunzio then concluded his talk with a summary that the implementation of the new 2014 ISUP classification warrants new tools to classify the risk of lymph node invasion better. Their novel contemporary predicting tool including ISUP grades and PSA density to predict lymph node invasion presented an excellent predictive accuracy. External validation is warranted before its clinical implementation


Presented by: Cosimo De Nunzio, Department of Urology, Ospedale Sant'andrea, Sapienza University

Written by: Abhishek Srivastava, MD, Society of Urologic Oncology Fellow, Fox Chase Cancer Center, Philadelphia, PA. Twitter: @shekabhishek at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois