Reply from Authors re: R. Jeffrey Karnes. To What Extent Can We Predict Prostate Cancer Lymph Node...
-
Upload
guilherme-godoy -
Category
Documents
-
view
212 -
download
0
Transcript of Reply from Authors re: R. Jeffrey Karnes. To What Extent Can We Predict Prostate Cancer Lymph Node...
![Page 1: Reply from Authors re: R. Jeffrey Karnes. To What Extent Can We Predict Prostate Cancer Lymph Node Involvement? Eur Urol 2011;60:202–3](https://reader030.fdocuments.in/reader030/viewer/2022020604/5750735b1a28abdd2e8effb0/html5/thumbnails/1.jpg)
Y 6 0 ( 2 0 1 1 ) 2 0 2 – 2 0 4
Platinum Priority
E U R O P E A N U R O L O G204
Reply from Authors re: R. Jeffrey Karnes. To What ExtentCan We Predict Prostate Cancer Lymph Node Involve-
ment? Eur Urol 2011;60:202–3Guilherme Godoy a,b, Jonathan A. Coleman a,*
a Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer
Center, New York, NY, USAb Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
Prostate cancer and its management is an ever-evolving
field, and perhaps this is the motivation and the central
theme of Karnes’ comments [1]. The landscape of patient
evaluation, treatment options, and refinements in treat-
ment technique is always broadening as the joint endeavors
of technology and experience develop apace. This is no less
evident in the approaches to surgical management and,
particularly, the role of lymphadenectomy in the curative
treatment of men with prostate cancer.
Adjunctive lymph node dissection has long been an
established component of surgical management and is part
of the basis of expectation for postoperative oncologic
outcomes. Still, this procedure remains poorly defined with
regard to necessary extent, utility of staging, and therapeu-
tic potential. Perhaps as a result of this ambiguity, among
other factors, there is a trend away from performing
lymphadenectomy during prostatectomy in the United
States, where nearly a third of cases are performed without
node dissection [2]. Concurrently, several groups are
investigating the use of more extended dissection templates
intended to increase the likelihood of detecting occult
positive nodal disease, although they effectively advocate
more invasive and extensive procedures without a defined
biologic end point. It is certainly possible to remove more
lymph nodes, although, taken to its conclusion, this line of
thinking could include a full bilateral template, nerve-
sparing retroperitoneal lymph node dissection. It seems
DOIs of original articles: 10.1016/j.eururo.2011.01.016,10.1016/j.eururo.2011.02.025* Corresponding author. Present address: Department of Surgery,Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York,NY 10065, USA. Tel. +1 646 422 4432; Fax: +1 212 452-3323.E-mail address: [email protected] (J.A. Coleman).
obvious that, like our surgical colleagues in breast cancer
research, the time has come to elucidate the role of this
procedure in routine practice [3].
In designing prospective trials for lymphadenectomy, it
is critical to define several parameters including the
population of at-risk patients needed to appropriately
power the study and the expected incidence of nodal
disease that would be anticipated among those patients.
Predictive instruments such as nomograms and look-up
tables help provide such data, and the more accurate,
standardized, and universal these resources are, the more
utility they provide. Inclusion of additional clinical features,
such as magnetic resonance imaging, has appeal but also
the potential to introduce greater error across institutions.
This updated nomogram offers improved discriminatory
function over its predecessor for dissection of external,
obturator, and hypogastric nodes and was developed to
better estimate patient risk for nodal involvement in these
areas preoperatively.
Conflicts of interest: The authors have nothing to disclose.
References
[1] Karnes RJ. To what extent can we predict prostate cancer lymph node
involvement?. Eur Urol 2011;60:202–3.
[2] Feifer A, Elkin E, Lowrance W, et al. Temporal trends in operative
management of pelvic lymph nodes in patients receiving open or
minimally invasive radical prostatectomy [abstract 128]. J Urol
2010;183:e52.
[3] Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no
axillary dissection in women with invasive breast cancer and sentinel
node metastasis: a randomized clinical trial. JAMA 2011;305:569–75.
doi:10.1016/j.eururo.2011.03.048