WHEN IS PELVIC LYMPH NODE DISSECTION NECESSARY BEFORE RADICAL PROSTATECTOMY? A DECISION ANALYSIS
- 1 October 2000
- journal article
- Published by Wolters Kluwer Health in Journal of Urology
- Vol. 164 (4) , 1235-1240
- https://doi.org/10.1016/s0022-5347(05)67147-9
Abstract
In recent years the role of pelvic lymph node dissection before or at radical prostatectomy has been questioned. We compared the outcome of performing or omitting pelvic lymph node dissection in patients undergoing radical retropubic prostatectomy by formal decision analysis. We created a decision tree for patients undergoing radical retropubic prostatectomy that accounts for all possible branch points and outcomes. Outcome probabilities applied to the model were derived from published data. Utility values were determined for each outcome state by a panel of experts. Decision analysis was done using decision analysis computer software. Sensitivity analysis was performed to determine which elements in the model were most important and to calculate threshold values. Using probability data from the literature and our assigned outcome values, decision analysis initially favored omitting pelvic lymph node dissection. Sensitivity analysis revealed that the threshold values for the incidence of positive lymph nodes and the sensitivity of lymph node dissection and frozen section analysis at which outcomes were equivalent were 18% and 80%, respectively. Analysis was insensitive to the pelvic lymph node dissection complication rate. We performed formal decision analysis to determine the incidence of lymph node metastasis below which pelvic lymph node dissection is not warranted at radical retropubic prostatectomy. Our results suggest that lymph node dissection is unnecessary in the subset of patients in which the risk of lymph node involvement is less than 18%.Keywords
This publication has 39 references indexed in Scilit:
- Evaluation of staging lymphadenectomy in prostate cancerUrology, 1998
- The staging pelvic lymphadenectomy: implications as an adjunctive procedure for clinically localized prostate cancerBritish Journal of Urology, 1997
- Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional updatePublished by American Medical Association (AMA) ,1997
- Predicting the patient at low risk for lymph node metastasis with localized prostate cancer: An analysis of four statistical modelsInternational Journal of Radiation Oncology*Biology*Physics, 1996
- Open pelvic lymph node dissection for prostate cancer: a reassessmentUrology, 1995
- Pelvic lymphadenectomy can be omitted in selected patients with carcinoma of the prostate: development of a system of patient selectionUrology, 1995
- Long-Term (15 Years) Results After Radical Prostatectomy For Clinically Localized (Stage T2c Or Lower) Prostate CancerJournal of Urology, 1994
- Eliminating the Need for Bilateral Pelvic Lymphadenectomy in Select Patients with Prostate CancerJournal of Urology, 1994
- The Contemporary Incidence of Lymph Node Metastases in Prostate Cancer: Implications for Laparoscopic Lymph Node DissectionJournal of Urology, 1993
- Lower Incidence of Unsuspected Lymph Node Metastases in 521 Consecutive Patients with Clinically Localized Prostate CancerJournal of Urology, 1992