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Predicting the Risk of Pelvic Node Involvement Among Men With Prostate Cancer in the Contemporary Era

      Purpose

      The “Roach formula” for the risk of pelvic lymph node metastases [(2/3) PSA + (Gleason score − 6) 10] was developed in the early prostate-specific antigen (PSA) era. We examined the accuracy of this formula in contemporary patients.

      Methods

      We included men in the Surveillance, Epidemiology, and End Results Registry with a diagnosis of clinical T1c–T4 prostate cancer in 2004 who had a surgical lymph node evaluation, Gleason score (typically from prostatectomy), and baseline PSA level (n = 9,387). Expected and observed rates of node positivity were compared.

      Results

      Ninety-eight percent were clinical T1c/T2, and 97% underwent prostatectomy. Overall, 309 patients (3.29%) had positive lymph nodes. Roach scores overestimated the actual rate of positive lymph nodes in the derivation set by 16-fold for patients with Roach score less than or equal to 10%, by 7-fold for scores greater than 10–20%, and by approximately 2.5-fold for scores greater than 20%. Applying these adjustment factors to Roach scores in the validation data set yielded accurate predictions of risk. For those with Roach score less than or equal to 10%, adjusted expected risk was 0.2% and observed risk was 0.2%. For Roach score greater than 10–20%, adjusted expected risk was 2.0% and observed risk was 2.1%. For Roach score greater than 20–30%, adjusted expected risk was 9.7% and observed risk was 6.5%. For Roach score greater than 30–40%, adjusted expected risk was 13.9% and observed risk was 13.9%.

      Conclusion

      Applied to contemporary patients with mainly T1c/T2 disease, the Roach formula appears to overestimate pelvic lymph node risk. The adjustment factors presented here should be validated by using biopsy Gleason scores and extended lymphadenectomies.
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      References

        • Roach III, M.
        • Marquez C.
        • Yuo H.S.
        • et al.
        Predicting the risk of lymph node involvement using the pre-treatment prostate specific antigen and Gleason score in men with clinically localized prostate cancer.
        Int J Radiat Oncol Biol Phys. 1994; 28: 33-37
        • Partin A.W.
        • Yoo J.
        • Carter H.B.
        • et al.
        The use of prostate specific antigen, clinical stage and Gleason score to predict pathological stage in men with localized prostate cancer.
        J Urol. 1993; 150: 110-114
        • Cooperberg M.R.
        • Moul J.W.
        • Carroll P.R.
        The changing face of prostate cancer.
        J Clin Oncol. 2005; 23: 8146-8151
      1. SEER Website. Available at: http://seer.cancer.gov/about/. Accessed February 15, 2008.

      2. SEER. Surveillance Epidemiology and End Results Program. SEERStat Database: Incidence - SEER 17 Regs Limited-Use, Nov 2006 Sub (1969-2004 varying) - Linked to County Attributes - Total U.S., 1969-2004 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2007, based on the Nov 2006 submission. Available at: www.seer.cancer.gov. Accessed February 15, 2008.

        • Smith E.B.
        • Frierson Jr., H.F.
        • Mills S.E.
        • et al.
        Gleason scores of prostate biopsy and radical prostatectomy specimens over the past 10 years: Is there evidence for systematic upgrading?.
        Cancer. 2002; 94: 2282-2287
        • Ghani K.R.
        • Grigor K.
        • Tulloch D.N.
        • et al.
        Trends in reporting Gleason score 1991 to 2001: Changes in the pathologist's practice.
        Eur Urol. 2005; 47: 196-201
        • Albertsen P.C.
        • Hanley J.A.
        • Barrows G.H.
        • et al.
        Prostate cancer and the Will Rogers phenomenon.
        J Natl Cancer Inst. 2005; 97: 1248-1253
        • Freedland S.J.
        • Kane C.J.
        • Amling C.L.
        • et al.
        Upgrading and downgrading of prostate needle biopsy specimens: Risk factors and clinical implications.
        Urology. 2007; 69: 495-499
        • Chun F.K.
        • Briganti A.
        • Shariat S.F.
        • et al.
        Significant upgrading affects a third of men diagnosed with prostate cancer: Predictive nomogram and internal validation.
        BJU Int. 2006; 98: 329-334
        • King C.R.
        • McNeal J.E.
        • Gill H.
        • et al.
        Extended prostate biopsy scheme improves reliability of Gleason grading: Implications for radiotherapy patients.
        Int J Radiat Oncol Biol Phys. 2004; 59: 386-391
        • Mian B.M.
        • Lehr D.J.
        • Moore C.K.
        • et al.
        Role of prostate biopsy schemes in accurate prediction of Gleason scores.
        Urology. 2006; 67: 379-383
        • Shah J.B.
        • McKiernan J.M.
        • Elkin E.P.
        • et al.
        Prostate biopsy patterns in the CaPSURE database: Evolution with time and impact on outcome after prostatectomy.
        J Urol. 2008; 179: 136-140
        • San Francisco I.F.
        • DeWolf W.C.
        • Rosen S.
        • et al.
        Extended prostate needle biopsy improves concordance of Gleason grading between prostate needle biopsy and radical prostatectomy.
        J Urol. 2003; 169: 136-140
        • Soloway M.S.
        • Pareek K.
        • Sharifi R.
        • et al.
        Neoadjuvant androgen ablation before radical prostatectomy in cT2bNxMo prostate cancer: 5-Year results.
        J Urol. 2002; 167: 112-116
        • Clark T.
        • Parekh D.J.
        • Cookson M.S.
        • et al.
        Randomized prospective evaluation of extended versus limited lymph node dissection in patients with clinically localized prostate cancer.
        J Urol. 2003; 169 (discussion, 147–148): 145-147
        • Bader P.
        • Burkhard F.C.
        • Markwalder R.
        • et al.
        Is a limited lymph node dissection an adequate staging procedure for prostate cancer?.
        J Urol. 2002; 168 (discussion, 518): 514-518
        • Heidenreich A.
        • Varga Z.
        • Von Knobloch R.
        Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: High incidence of lymph node metastasis.
        J Urol. 2002; 167: 1681-1686
        • Briganti A.
        • Chun F.K.
        • Salonia A.
        • et al.
        Critical assessment of ideal nodal yield at pelvic lymphadenectomy to accurately diagnose prostate cancer nodal metastasis in patients undergoing radical retropubic prostatectomy.
        Urology. 2007; 69: 147-151

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