Radical prostatectomy findings in patients with locally aggressive Grade group 5 prostatic adenocarcinoma and negative limited or extended pelvic lymph node dissection.

Current management options for high-risk prostate cancer (PCa) patients include radical prostatectomy with lymph node dissection and other local or systemic therapeutic approaches. However, there is paucity of data in the pathology literature on the radical prostatectomy findings in patients with locally aggressive Grade group 5 PCa with negative limited or extended lymph node dissection. A search was made through our Urologic Pathology files and consults of the senior author for patients who had radical prostatectomy specimens with locally aggressive Grade group 5 PCa and limited or extended lymph node dissection from 2010 to 2022. Patients with lymph node metastasis were excluded. Clinicopathologic and follow up data were obtained. Forty-two patients were included in the study. Mean age was 64 years (range: 49-79 years). Forty-one (98 %) patients had PCa Gleason score 4 + 5 = 9 and 1 (2 %) patient had Gleason score 5 + 4 = 9. Extraprostatic extension and/or bladder neck invasion was present in 30 (71 %) patients and seminal vesicle invasion was present in 20 (48 %) patients, of which 10 (50 %) were bilateral. Extended lymph node dissection was performed in 18 patients with mean of 22 lymph nodes (range: 6-51 lymph nodes). Limited lymph node dissection was performed in 24 patients with mean of 7 lymph nodes (range: 2-25 lymph nodes). This study demonstrates that a subset of patients with very advanced/high grade PCa still benefit from radical prostatectomy/tumor debulking even in the setting of positive margins, and may not have lymph node metastasis.