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Lymph Node Metastases in Prostate Cancer

Prostate cancer like many other cancers can spread to the lymph nodes. The prognosis for patients with node metastases (stage D1) is more serious and the proper treatment is controversial (as noted below.) Traditionally if spread to the nodes is detected at the time of surgery (radical prostatectomy) the surgery is usually cancelled (on the basis that the cancer has spread too far to benefit from proceeding with surgery.) Some studies, however. show patients do much better if surgery is performed. Patients with node spread are usually treated instead with hormonal therapy, radiation, or the combination. In patients whose node status is unknown (not biopsied) it is controversial whether the radiation fields should include the nodes or not. Some of the studies that demonstrate these controversies are shown below.

The odds that the cancer has spread to the nodes can be estimated from the data below (based on the pathologic findings from surgery performed on 4,133 cases (Partin. JAMA 1997;277:1448)

Stage + nodes Gleason + nodes PSA + nodes
T1a 1% 2-4 < 1% 0-4 1%
T1b 5% 5 1% 4.1-10 3%
T1c 3% 6 3% 10.-20 9%
T2a 3% 7 10% 20.1-30 12%
T2b 8% 8-10 20% 30.1-40 23%
T2c 10%     40.1-50 23%
T3a 20%     >50 27%

Three of the most significant questions about these patients:

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