Oncologic outcomes in men with metastasis to the prostatic anterior fat pad lymph nodes: a multi-institution international study.

The presence of lymph nodes (LN) within the prostatic anterior fat pad (PAFP) has been reported in several recent reports. These PAFP LNs rarely harbor metastatic disease, and the characteristics of patients with PAFP LN metastasis are not well-described in the literature.

Our previous study suggested that metastatic disease to the PAFP LN was associated with less severe oncologic outcomes than those that involve the pelvic lymph node (PLN) Therefore, the objective of this study is to assess the oncologic outcome of prostate cancer (PCa) patients with PAFP LN metastasis in a larger patient population

Data were analyzed on 8800 patients from eleven international centers in three countries Eighty-eight patients were found to have metastatic disease to the PAFP LNs (PAFP+) and 206 men had isolated metastasis to the pelvic LNs (PLN+) Clinicopathologic features were compared using ANOVA and Chi square tests The Kaplan-Meier method was used to calculate the time to biochemical recurrence (BCR)

Of the eighty-eight patients with PAFP LN metastasis, sixty-three (71 6%) were up-staged based on the pathologic analysis of PAFP and eight (9 1%) had a low-risk disease Patients with LNs present in the PAFP had a higher incidence of biopsy Gleason score (GS) 8-10, pathologic N1 disease, and positive surgical margin in prostatectomy specimens than those with no LNs detected in the PAFP Men who were PAFP+ with or without PLN involvement had more aggressive pathologic features than those with PLN disease only However, there was no significant difference in BCR-free survival regardless of adjuvant therapy In 300 patients who underwent PAFP LN mapping, 65 LNs were detected It was also found that 44 out of 65 (67 7%) nodes were located in the middle portion of the PAFP

There was no significant difference in the rate of BCR between the PAFP LN+ and PLN+ groups The PAFP likely represents a landing zone that is different from the PLNs for PCa metastasis Therefore, the removal and pathologic analysis of PAFP should be adopted as a standard procedure in all patients undergoing radical prostatectomy

BMC urology 2015 Aug 01*** epublish ***

Young Suk Kwon, Yun-Sok Ha, Parth K Modi, Amirali Salmasi, Jaspreet S Parihar, Neal Patel, Izak Faiena, Michael May, David I Lee, Elton Llukani, Tuliao Patrick, Koon Ho Rha, Thomas Ahlering, Douglas Skarecky, Hanjong Ahn, Seung-Kwon Choi, Sejun Park, Seong Soo Jeon, Yen-Chuan Ou, Daniel Eun, Varsha Manucha, David Albala, Ketan Badani, Bertram Yuh, Nora Ruel, Tae-Hwan Kim, Tae Gyun Kwon, Daniel Marchalik, Jonathan Hwang, Wun-Jae Kim, Isaac Yi Kim

Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, The State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ, USA yk411@cinj rutgers edu , Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, T

he State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ, USA yunsokha@gmail com , Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, The State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ, USA modi parth@gmail com , Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, The State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ, USA salmasi armirali@gmail com , Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, The State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ, USA jaspreetparihar@gmail com , Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, The State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ, USA patel neal@gmail com , Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, The State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ, USA faienaiz@rwjms rutgers edu , Department of Pathology, Robert Wood Johnson Medical School, New Brunswick, NJ, USA mayms@rwjmslrutgers edu , Division of Urology, University of Pennsylvania, Philadelphia, PA, USA david lee@uphs upenn edu , Division of Urology, University of Pennsylvania, Philadelphia, PA, USA elton llukani@uphs upenn edu , Department of Urology, College of Medicine, Yonsei University, Seoul, Korea patrick@yuhs ac , Department of Urology, College of Medicine, Yonsei University, Seoul, Korea khrha@yuhs ac , Department of Urology, UC Irvine School of Medicine, Orange, CA, USA tahlerin@uci edu , Department of Urology, UC Irvine School of Medicine, Orange, CA, USA dwskarec@uci edu , Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea hiahn@amc seoul kr , Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea cherynsong@amc seoul kr , Department of Urology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea geheimnis79@hanmail net , Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea seongsoo jeon@samsung com , Prostate Disease Center, Taichung Veterans General Hospital, Taichung, Taiwan ycou@vghtc gov tw , Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA daniel eun@tuhs temple edu , Department of Pathology, Temple University School of Medicine, Philadelphia, PA, USA varsha manucha@tuhs temple edu , Associated Medical Professionals, Syracuse, NY, USA dalbala@luc edu , Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA ketanbadani@gmail com , Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA byuh@coh org , Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA nruel@coh org , Department of Urology, School of Medicine, Kyungpook National University Medical Center, Daegu, Korea doctork@knu ac kr , Department of Urology, School of Medicine, Kyungpook National University Medical Center, Daegu, Korea tgkwon@knu ac kr , Department of Urology, Georgetown University, Washington, DC, USA dan marchalik@gmail com , Department of Urology, Georgetown University, Washington, DC, USA jonathan j hwang@medstar net , Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea wjkim@chungbuk ac kr , Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, The State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ, USA  

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