Detailed Analysis of Prostate Cancer Patients with Metastasis to the Prostatic Anterior Fat Pad Lymph Nodes: a Multi-Institution Study

 

 

Abstract 

Purpose

The presence of lymph nodes within the prostatic anterior fat pad (PAFP) has been reported recently. Rarely, these PAFP lymph nodes harbor metastatic disease. The characteristics of patients with PAFP lymph node metastasis are not well described in the literature. The purpose of the present study was to identify perioperative characteristics and assess clinical outcomes of patients with PAFP lymph node metastases.

 

Materials and Methods

From eight tertiary care centers, 4261 patients underwent a complete removal and pathologic analysis of PAFP. In patients with metastatic disease to the PAFP,preoperative and pathologic characteristics as well as clinical management and outcomes are described.

 

Results

Metastatic disease to the PAFP lymph nodes was detected in forty patients (0.94%). Thirty-seven of these patients (92.5%) had intermediate or high-risk features pre-operatively. Most patients with PAFP metastases underwent concomitant pelvic lymph node dissection (PLND) and had adjuvant therapy with radiation, androgen ablation, and/or chemotherapy. Twenty-seven patients (67.5%) with PAFP metastatic disease were upstaged as a result of PAFP pathologic analysis of whom 14 (51.8%) remained free of biochemical recurrence (BCR) with observation and/or definitive adjuvant/salvage therapy.

 

Conclusions

Most patients with PAFP metastatic disease had intermediate to high-risk features pre-operatively. In some patients with metastasis to the PAFP lymph nodes, removal of these lymph nodes resulted in prolonged BCR free survival. Therefore, we recommend that the PAFP be removed in all patients undergoing radical prostatectomy. However, pathologic analysis of the PAFP may be limited to patients with pre-operative intermediate to high-risk oncologic features.

 

 

 

 

http://www.jurology.com/article/S0022-5347(13)00349-2/abstract