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• W2023266051 abstract "You have accessJournal of UrologyProstate Cancer: Staging (II)1 Apr 2013371 ARE WE OVER PERFORMING PELVIC LYMPH NODE DISSECTION IN PROSTATE CANCER? Matthew Lane Purcell, Patrick Yu, Rhiannon Deierhoi, James E. Bryant, and J. Erik Busby Matthew Lane PurcellMatthew Lane Purcell Birmingham, AL More articles by this author , Patrick YuPatrick Yu Birmingham, AL More articles by this author , Rhiannon DeierhoiRhiannon Deierhoi Birmingham, AL More articles by this author , James E. BryantJames E. Bryant Birmingham, AL More articles by this author , and J. Erik BusbyJ. Erik Busby Greenville, SC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1759AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The 2009 NCCN prostate cancer guidelines changed the recommendations for including pelvic lymph node dissection (PLND) with radical prostatectomy (RP) from ≥7% risk of lymph node (LN) metastasis to ≥2% risk. This increases the number of PLND that would need to be performed based on available nomograms. PLND is not without complication and increases time and cost. We sought to examine patients at our institution who underwent RP with PLND to determine the differential in node findings between these risk groups with a goal of assessing the value to patients and subsequent costs. METHODS We retrospectively evaluated data on 825 patients undergoing RP at our institution from 12/1999 to 11/2011. We developed models to determine who should have undergone PLND based on pre-2009 to post-2009 NCCN guidelines. We also used a separate model based on the D'Amico risk criteria, which is what our institution currently uses (PLND offered to patients with intermediate or high risk criteria). Using these models we examined how many patients were over-treated with PLND and how many patients with positive nodes were missed. RESULTS 329 (39.9%) patients underwent PLND. 18 (5.5%) patients undergoing PLND had positive nodes. Using the pre-2009 NCCN guidelines, only 66 PLND needed to be performed, but would have missed 5 patients with positive nodes (27.8% undiagnosed). Using the post-2009 NCCN guidelines, 157 patients should have undergone PLND, but would have missed 2 patients with positive nodes (11.1% undiagnosed). Using the D'Amico risk model, 258 patients would have undergone PLND, but no patients with positive nodes would have been missed. The positive predictive values (PPV) for the pre-2009 NCCN guidelines, post-2009 NCCN guidelines and D'Amico models are 16.5%, 9.2%, and 10.2% respectively. The number needed to treat (NNT) in order to detect one LN positive patient is 6.9, 12.7, and 9.8 respectively. None of these were statistically superior as a model for predicting nodal disease. When analyzing our institution's use of PLND, if we had used the pre-2009, post-2009 or D'Amico models we would have saved 245 (79.9%), 154 (52.3%) and 51 (21.6%) PLND. CONCLUSIONS There is a difficult balance between over performing PLND and under diagnosing LN positive disease. Using the current recommendations, we may be over performing PLND, increasing patient risks and procedure costs. The pre-2009 NCCN guidelines offer best prediction (16% PPV) and lowest NNT (6.9), although it is not significantly different from the models based on the current guidelines or D'Amico criteria. A new model is clearly needed to optimize this balance. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e150 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Metrics Author Information Matthew Lane Purcell Birmingham, AL More articles by this author Patrick Yu Birmingham, AL More articles by this author Rhiannon Deierhoi Birmingham, AL More articles by this author James E. Bryant Birmingham, AL More articles by this author J. Erik Busby Greenville, SC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ..." @default.
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• W2023266051 date "2013-04-01" @default.
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• W2023266051 title "371 ARE WE OVER PERFORMING PELVIC LYMPH NODE DISSECTION IN PROSTATE CANCER?" @default.
• W2023266051 doi "https://doi.org/10.1016/j.juro.2013.02.1759" @default.
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