Beyond The Abstract: Anatomic Excision Of Anterior Prostatic Fat At Radical Prostatectomy: Implications For Pathologic Upstaging

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health
Article Date: 08 Mar 2008 - 0:00 PDT

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UroToday.com - It is very exciting when you take an operation that has been around since 1905 and uncover new information that was literally right in front of us all along. We found several interesting things. First, we found lymph nodes in the anterior prostatic fat (APF) in about 15% of men undergoing radical prostatectomy (RRP).This is really a new finding. A paper by Kothari and Scardino in 2001 did describe lymph nodes around this area of the prostate, but did not specifically discuss the APF. Traditionally during RRP this fat is discarded. This study suggests that perhaps we should be looking at this fat more carefully. Our second finding was the presence of metastases to these nodes in about 2% of patients, particularly in those that had anterior prostate cancers. Of note, one of the patients with a positive APF node had low risk disease (Gleason 3+3 with a PSA of 8.6 ng/mL). Surprisingly, in two other patients with positive APF nodes, their pelvic lymph node dissection was negative, which is of concern. Three of the 4 patients with positive nodes were upstaged as a result of APF node detection. Finally, we found that an anatomic dissection of the APF improved visualization and vascular control of the DVC as well as more clearly identifying the apex. A fertile area of future study will be lymphatic mapping of the APF.

Written by David S. Finley, MD and Thomas E. Ahlering, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract.

Link to original abstract

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