Is preoperative computed tomography necessary in the management of patients treated for carcinoma of the prostate by 125iodine interstitial implantation and bilateral pelvic lymphadenectomy?

We have evaluated the impact of preoperative pelvic computed tomography (PCT) on the management of 145 patients with adenocarcinoma of the prostate. Our preoperative interpretations were correct in 47 (76%) of the 62 cases with PCT. Twenty-six percent of the 62 patients had microscopically positive lymph nodes, and, of this subgroup, only 50% remain disease-free, at risk for 1 to 7 1/2 years. In contrast, 93% of the subgroup with microscopically negative lymph nodes are free of disease. Of the 83 patients who did not have PCT preoperatively, 18 patients (22%) had microscopically positive lymph nodes and 33% are disease-free; 65 patients (78%) had microscopically negative lymph nodes, and 90% are disease-free, followed for 1 1/2 to 9 years. Thus, there is no significant difference in percent nodal positivity, or disease-free survivals, when comparing the PCT and non-PCT groups, subdivided according to nodal status. We believe that preoperative PCT is an important screening tool, and will provide correct pathological correlations in the majority of cases. However, on the basis of the information derived from this study, the preoperative clinical assessment patients fared no differently from the preoperative PCT patients, thus suggesting that PCT may not be indicated routinely, but should be reserved for questionable situations.