Significance of Positive Nodes and Positive Margins
Approximately 30% of patients with prostatic malignancy clinically confined to the organ of origin by rectal examination or by ultrasound examination have extension of malignancy to the regional pelvic lymph nodes. Involvement of the regional pelvic nodes is felt to reflect extension of the malignancy from the primary organ of origin and to identify patients at increased risk for failure following the administration of local treatment. Noninvasive imaging studies have been demonstrated to be incapable of predicting regional lymph node involvement with sufficient accuracy that clinical decisions can be reasonably made. The use of biological or biochemical markers may identify patients with an increased statistical probability of having lymph node involvement, and while they may be informative, the tests are not conclusive. In response to these facts, staging lymphadenectomy has been routinely considered as an appropriate preliminary study before definitive treatment selection of apparently organ-confined disease can be undertaken. Nonetheless, there still remain several controversial areas with respect to staging pelvic lymphadenectomy.
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