PSA density versus risk stratification for lymphadenectomy-making decision in patients with prostate cancer undergoing radical prostatectomy.

Objectives: To determine the value of PSA density as independent predictor for lymph node invasion in order to decide lymphadenectomy in patients undergoing radical prostatectomy.

Patients And Methods: We retrospectively analyzed the medical records of 179 patients who undergone radical prostatectomy from January 2001 until September 2010. Studied patients divided in groups regarding the preoperative risk for lymph node metastasis (low risk or not) and PSA density (≤.2 or greater). Age, prostate volume, preoperative PSA, and preoperative Gleason score (≤ 6 or ≥ 7) were estimated as well. We analyze the impact of the above factors in prediction of lymph nodes metastasis after radical prostatectomy.

Results: One patient found to have lymph node invasion out of 48 who stratified as low-risk patients and 1 out of 77 who had PSA density ≤.2. There was a significant correlation between preoperative PSA, PSA density, and risk stratification among patients who had metastasis or not. These findings confirmed in the univariate analysis of these factors. However, in multivariate analysis, PSA density was the only statistically significant predictor.

Conclusion: This is the first study to compare preoperative risk stratification and PSA density as predictors of lymph node metastasis in patients who are planned for radical prostatectomy. PSA density values ≤.2 can predict lymph nodes metastasis in a larger population of patients and consequently can potentially decrease the number of lymphadenectomies during radical prostatectomy procedures.