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Removing
lymph nodes beyond the conventional area in men undergoing
surgery for localized prostate cancer detects the spread of
cancer far better than standard lymphadenectomy, according
to German researchers.
The researchers,
reporting in the Journal of Urology, said what is called "extended
pelvic lymphadenectomy" is particularly useful in detecting
lymph node cancer in patients with high prostate specific
antigen (PSA) levels and high Gleason scores.
Dr. Axel
Heidenreich from Philipps-University Marburg compared results
of extended pelvic lymphadenectomies performed on 103 patients
undergoing prostate surgery with results for 100 similar patients
who had nodes removed from the most likely pelvic lymphatic
sites.
He reported
that cancer was found in the lymph nodes of 27 of the 103
who underwent the extended procedure, while it was detected
in only 12 of the 100 patients who underwent the conventional
procedure.
He reported
that 26 of the 27 patients with lymph node cancer found in
the extended procedure had PSA levels greater than 10.5 and
a preoperative Gleason score of 7 or more.
The researchers
reported that a low risk of 2 percent for lymph node disease
was observed in patients with serum PSA less than 10.5 and
Gleason score, and concluded that these "low-risk patients
do not need to undergo staging pelvic lymphadenectomy."
But "all
others should undergo extended pelvic lymphadenectomy including
the lymph nodes of the external and internal iliac, and obturator
fossa groups," the researchers recommended.
Source:
Prostate Cancer
Week of April 28, 2002
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