An evaluation of lymphography with nodal biopsy in localized carcinoma of the prostate. URO-Oncology Research Group.

One hundred forty-nine lymphograms from patients with localized carcinomas of the prostate were interpreted by a referee radiologist without the benefit of clinical stage, grade of tumor, or the result of staging pelvic node dissection. The lymphogram was able to detect 30 of 35 (86%) positive nodal metastases and confirm 90 of 114 (79%) negative nodal biopsies. The internal iliac nodal biopsies were positive as a single finding in only 7 of 54 (13%) patients. The total external iliac nodal involvement was 41 of 54 (76%). High-grade prostate cancer patients have twice the incidence of positive nodal biopsies and lymphograms. Lymphography detected 43% of positive nodal patients with normal acid phosphatase and 69% of positive nodal patients with elevated acid phosphatase determinations. The lymphogram and tumor grade (prostate) are considered significant potential predictors of lymph node biopsy result. Finally, the incidence of nodal metastasis in localized prostatic cancer from surgical and histologically confirmed lymphogram series is reviewed with the concept of sensitivity and specificity of the lymphogram.