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Detection of Occult Lymph Node Metastases in Locally Advanced Node-Negative Prostate Cancer

Vincenzo Pagliarulo, Debra Hawes, Frank H. Brands, Susan Groshen, Jie Cai, John P. Stein, Gary Lieskovsky, Donald G. Skinner, Richard J. Cote

From the Departments of Pathology, Urology, and Preventive Medicine, University of Southern California, Keck School of Medicine; and the University of Southern California/Kenneth Norris Comprehensive Cancer Center, Los Angeles, CA

Address reprint requests to Richard J. Cote, MD, University of Southern California/Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, Los Angeles, CA 90033; e-mail: cote_r{at}ccnt.hsc.usc.edu

PURPOSE: The purpose of this study was to determine the incidence and clinical significance of occult metastases in the lymph nodes of patients with prostate cancer originally considered node negative by routine histologic evaluation.

METHODS: Two hundred seventy four patients with pT3 prostate carcinoma treated by radical prostatectomy and bilateral lymph node dissection were included in this study. One hundred eighty patients were staged node negative (N0), while 94 patients were lymph node positive (N+), based on routine histologic evaluation. All lymph nodes from the 180 N0 patients were evaluated for occult metastases by immunohistochemistry using antibodies to cytokeratins and, if positive, prostate-specific antigen. Recurrence and overall survival were compared among patients with occult tumor cells (OLN+), with patients whose lymph nodes remained negative (OLN–), and with the 94 N+ patients.

RESULTS: A total of 3,914 lymph nodes were evaluated from 180 N0 patients (average, 21.7 lymph nodes per patient). Occult tumor cells were found in 24 of 180 patients (13.3%). The presence of OLN+ was significantly associated with increased recurrence and decreased survival compared with OLN– patients (P < .001 and P = .019, respectively; relative risk of recurrence, 2.27; relative risk of death 2.07, respectively). The presence of occult lymph node metastases was an independent predictor of recurrence and death in a multivariable analysis. The outcome for patients with OLN+ disease was similar to that for patients with N+ disease.

CONCLUSION: The detection of occult lymph node metastases in patients with pT3N0 prostate cancer identifies those with significantly increased risk of prostate cancer recurrence and death.

Supported by Grants No. P30 CA14089 and CA59705 from the National Institute of Health and National Cancer Institute, PC 970406 from the Department of Defense, and 1-II-0181 from the California Cancer Research Program.

There are no directly related manuscripts or abstracts, published or unpublished, by any authors of this paper.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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