[Is there a place for radical prostatectomy without lymphadenectomy?].

Objectives: Herein we present the procedure we have followed to determine N+ low-risk factors which allow us to identify those patients with prostate cancer in whom radical perineal prostatectomy (RPP) can be performed without a previous staging lymphadenectomy, thereby maintaining the oncological principles but with less morbidity.

Methods: In a series of 88 patients who underwent RPP, we identified an N+ low-risk factor group; i.e., patients with clinically localized tumor of the prostate gland, a Gleason score of < or = 7 and PSA < or = 10 ng/ml. The foregoing criteria were based on the findings reported by Stamey and the status of the lymph nodes of our own series of radical prostatectomies.

Results: In 71 of the 88 patients with a follow up of more than one year, RPP was performed after laparoscopic pelvic lymphadenectomy. Of these 71 patients, 17 (19.3%) presented the above-mentioned low-risk characteristics and were all pN-. Since then, the subsequent patients who met this low-risk criteria (n = 17; 19.3% of the total) were submitted to RPP alone without previous staging lymphadenectomy. The rate of positive margins in this group was 17.6%, all cases maintaining PSA within feminization levels after a mean follow-up of 21.7 months. Considering the overall series, 38.6% of the patients could have avoided lymphadenectomy according to our criteria.

Conclusions: We have found RPP without previous staging lymphadenectomy to be a valid therapeutic option for patients with clinically localized prostate cancer, preoperative PSA < or = 10 ng/ml and a Gleason score of < or = 7. According to our data, this group accounts for approximately 40% of the patients in whom radical prostatectomy had been recommended.