Abstract
Introduction:
Staging PLA in high risk prostate cancer may help to determine suitability for radical treatment or whole pelvis radiation. Additionally, long-term androgen deprivation therapy may be avoided. We assess the role and safety of PLA.
Methods:
Patients with high-risk prostate cancer were selected prospectively. Indications for PLA included a risk of nodal metastases >30% (Roach formula, clinical T3 or radiological N1 disease on MRI). Standard template lymphadenectomy was performed.
Results:
36 patients underwent staging PLA. No statistically significant difference in Gleason score, T stage, presenting PSA, or number of nodes resected, was seen for node positive disease. Mean PSA was 44.5 ng/ml.
95% of patients were discharged within 24 h, with no intra-operative complications. The mean number of nodes removed was 14 (SD ± 4). 30% (10/36) experienced early complications which resolved (lymphocoele formation 13%, lymphoedema 8%, scrotal oedema 3%, and obturator nerve paraesthesia 5%). One patient developed a small pulmonary embolus and was anti-coagulated. Node positivity was observed in 30% of patients with PLA compared to 19% detected on MRI. Overall, 70% of cases were node negative and did not undergo whole pelvic radiotherapy, which would have been standard treatment. PLA upstaged MR from N0 to N1 in 36% of cases, and down-staged radiological N1 to N0 disease in 8%.
Conclusions:
Staging PLA provides valuable prognostic data. It is a well-tolerated diagnostic modality but is associated with morbidity in keeping with published data. It appears more reliable than conventional MRI in stratifying patients suitable for whole pelvis radiotherapy.