Should we reconsider the indications for ileo-obturator node dissection with XXXX ?

@entity1 @entity263 @entity66 @entity5 @entity13712 @entity3 @entity1486
OBJECTIVE: To evaluate the need for ileo-obturator node dissection in @entity1 with @entity263 who are undergoing radical retropubic prostatectomy. @entity1 AND METHODS: Over a 5-year-period, 95 @entity1 underwent bilateral pelvic lymphadenectomy. Ninety were performed in association with planned radical prostatectomy and five were staging procedures in clinical stage T3 @entity1 prior to radiotherapy or hormonal therapy. The @entity1 with @entity263 were stage @entity13712 (one @entity1 ), T1b (21), T2a (30), and T2b (38). Pre-operative biopsies in the @entity1 with @entity5 were well differentiated in 44 @entity1 , moderately well differentiated in 45 and poorly differentiated in one. In the @entity1 with T3 @entity5 , pre-operative biopsies were well differentiated in one, moderately well differentiated in two and poorly differentiated in two. @entity1486 (PSA) levels ranged from 0.4 to 110.1 ng/mL (Hybritech assay). RESULTS: Two @entity1 had positive lymph node dissections on fixed section. These two @entity1 had well-differentiated @entity66 with a PSA level of 72.4 ng/mL and poorly differentiated @entity66 with a PSA level of 58.5 ng/mL. There was significant upstaging (P < 0.001) and upgrading (P < 0.001) on pathological examination. None of the 71 @entity1 with a PSA < or = 10 ng/mL had positive lymph nodes compared with 8.3% of the 24 @entity1 with a PSA > 10 ng/mL (P = 0.0618). Lymph node @entity3 were present in 1% of @entity1 with well or moderately well-differentiated @entity263 on pre-operative biopsy versus 33% with poorly differentiated disease (P = 0.0625). These P values strongly suggest an association, achieving significance only at the 10% level which might be the more appropriate level given the relative lack of power of the study due to the small number of @entity1 with positive lymph nodes. CONCLUSION: These results suggest that routine ileo-obturator node dissection in @entity1 with well or moderately well-differentiated, @entity263 and a PSA level < 10 ng/mL may be unnecessary, especially as a separate procedure.
