Section of Urologic Oncology and Dean and Betty Gallo Prostate Cancer Center, The Cancer Institute of New Jersey/Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA.
Urol Oncol. 2013 Jan;31(1):63-7. doi: 10.1016/j.urolonc.2010.09.003. Epub 2011 Mar 10.
Lymph node status has significant pathologic implications in patients with prostate cancer. In this study, we have performed pathologic analysis of prostatic anterior fat pad (PAFP) excised during robot-assisted radical prostatectomy (RARP) to investigate the potential role of AFP on pathologic staging of prostate cancer.
A total of 258 consecutive patients underwent PAFP excision during RARP between July 2007 and June 2009. PAFP was removed and submitted en bloc to the pathology department and evaluated for the presence of lymphoid tissue and metastatic prostate cancer. Retrospective chart review was performed for all patients.
Of the 258 patients, 30 (11.6%) had 1 or 2 PAFP lymph nodes and 228 (88.4%) men showed no lymphoid tissue in their PAFPs. Preoperatively, mean PSA level was higher in the former group. There were no significant pathologic differences between the 2 groups. Among the 30 patients with PAFP lymph nodes, 3 were positive for metastatic prostate cancer. All 3 of these patients had high-risk features preoperatively. In 1 patient, the pelvic lymph nodes were negative for metastatic prostate cancer. At 2-year follow-up, PSA level of this patient was undetectable.
Herein, we demonstrated that the PAFP contained lymph nodes in over 11% of the patients undergoing RARP at our institution. Prostate cancer was upstaged in 1 patient as a result of PAFP excision. Since this patient is free of biochemical recurrence at 2 years, routine excision and pathologic analysis of PAFP should be considered in prostate cancer patients undergoing radical prostatectomy.
淋巴结状态对前列腺癌患者具有重要的病理意义。本研究通过对机器人辅助前列腺根治性切除术（RARP）中切除的前列腺前脂肪垫（PAFP）进行病理分析，探讨 AFP 在前列腺癌病理分期中的潜在作用。
2007 年 7 月至 2009 年 6 月，连续 258 例患者在 RARP 中切除 PAFP。PAFP 整块切除并提交给病理科，评估是否存在淋巴组织和转移性前列腺癌。对所有患者进行回顾性图表审查。
在 258 例患者中，30 例（11.6%）有 1 或 2 个 PAFP 淋巴结，228 例（88.4%）患者的 PAFP 中无淋巴组织。前者的平均 PSA 水平较高。两组间无显著病理差异。在 30 例有 PAFP 淋巴结的患者中，3 例转移性前列腺癌阳性。这 3 例患者术前均具有高危特征。在 1 例患者中，盆腔淋巴结未发现转移性前列腺癌。在 2 年随访时，该患者的 PSA 水平无法检测到。
本研究表明，在我们机构行 RARP 的患者中，超过 11%的患者的 PAFP 中含有淋巴结。PAFP 切除导致 1 例患者前列腺癌分期升高。由于该患者在 2 年内无生化复发，对于行根治性前列腺切除术的前列腺癌患者，应考虑常规切除和分析 PAFP。
