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


      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.


      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.


      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%.


      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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