Preoperative variables predicting pelvic lymphnodes involvement. Is lymph nodes dissection still a must before radical prostatectomy?

32 patients with confined (localized) prostate cancer histologically confirmed have been included in a retrospective study, 16 patients underwent laparoscopic staging lymphadenectomy, meanwhile another group of 16 patients had a lymphadenectomy as a part of radical sovrapubic prostatectomy. 25% of laparoscopic lymphadenectomy patients were N+ and subsequently have been treated with hormonotherapy. The whole cohort was analysed without division based on type of lymphadenectomy procedure. The patients were stratified as: a) Clinical stage by DR, and TRUS and biopsy; b) Grade: (1) low grade Ml, (2) medium grade III-IV (3) high grade; c) PSA score: (1) PSA<10 ng/ml, (2) PSA >10<20 ng/ml, (3) PSA > 20 ng/ml. Taking the pathologic stage as dependent variable factor and all other data as independent variable factors a statistic analysis was carried out aiming to predict the progression at the pathologic stage as dependent factor. Clinical stage: 77% of stage T l c- T2a-b patients had localised disease but only 24% of stages T2c and T3a were prostatic confined diseases. 24% of T2c and 21 % of T3a were N+. PSA: 64% with PSA below 10 ng/ml had intracapsular neoplasm and 40% with PSA higher than 20 mg/ml had been N+. Primary Gleason grade: 55.7% of low grade neoplasm were intracapsular, 74.4% of high grade were extracapsular with 45% of N+. A discriminant analysis was first performed on three group: 1) intracapsular, 2) extracapsular (locally advanced), 3) with lymphnodes metastasis. Lymphnode invasion was predictable in 63% of cases. The discriminant analysis correctly divide the subject with low stage from the restant with locally advanced disease and from those with lymphnode metastases but it does not allow to separate locally advanced disease bearers from patients with lymphnodes invasion. This is probably due to the fact that often locally advanced tumour and lymphnode invasion cosiest. The logistic regression identifies the association of Psa (p=0.000), clinical stage (p=0.001) and primary Gleason grade as valuable factors in predicting pathological stage (75%). Only the patients with organ confined prostate cancer can benefit from radical prostatectomy. The best problem is not to identify node positive disease, often associated with extracapsular disease but to select prior the surgery the patients with a potentially extracapsular extension of the cancer.