Oncologic outcomes in men with metastasis to the prostatic anterior fat pad lymph nodes: A multi-institution international study

Young Suk Kwon, Yun Sok Ha, Parth K. Modi, Amirali Salmasi, Jaspreet S. Parihar, Neal Patel, Izak Faiena, Michael May, David I. Lee, Elton Llukani, Tuliao Patrick, Koon Ho Rha, Thomas Ahlering, Douglas Skarecky, Hanjong Ahn, Seung Kwon Choi, Sejun Park, Seong Soo Jeon, Yen Chuan Ou, Daniel EunVarsha Manucha, David Albala, Ketan Badani, Bertram Yuh, Nora Ruel, Tae Hwan Kim, Tae Gyun Kwon, Daniel Marchalik, Jonathan Hwang, Wun Jae Kim, Isaac Yi Kim

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)


Background: The presence of lymph nodes (LN) within the prostatic anterior fat pad (PAFP) has been reported in several recent reports. These PAFP LNs rarely harbor metastatic disease, and the characteristics of patients with PAFP LN metastasis are not well-described in the literature. Our previous study suggested that metastatic disease to the PAFP LN was associated with less severe oncologic outcomes than those that involve the pelvic lymph node (PLN). Therefore, the objective of this study is to assess the oncologic outcome of prostate cancer (PCa) patients with PAFP LN metastasis in a larger patient population. Methods: Data were analyzed on 8800 patients from eleven international centers in three countries. Eighty-eight patients were found to have metastatic disease to the PAFP LNs (PAFP+) and 206 men had isolated metastasis to the pelvic LNs (PLN+). Clinicopathologic features were compared using ANOVA and Chi square tests. The Kaplan-Meier method was used to calculate the time to biochemical recurrence (BCR). Results: Of the eighty-eight patients with PAFP LN metastasis, sixty-three (71.6 %) were up-staged based on the pathologic analysis of PAFP and eight (9.1 %) had a low-risk disease. Patients with LNs present in the PAFP had a higher incidence of biopsy Gleason score (GS) 8-10, pathologic N1 disease, and positive surgical margin in prostatectomy specimens than those with no LNs detected in the PAFP. Men who were PAFP+ with or without PLN involvement had more aggressive pathologic features than those with PLN disease only. However, there was no significant difference in BCR-free survival regardless of adjuvant therapy. In 300 patients who underwent PAFP LN mapping, 65 LNs were detected. It was also found that 44 out of 65 (67.7 %) nodes were located in the middle portion of the PAFP. Conclusions: There was no significant difference in the rate of BCR between the PAFP LN+ and PLN+ groups. The PAFP likely represents a landing zone that is different from the PLNs for PCa metastasis. Therefore, the removal and pathologic analysis of PAFP should be adopted as a standard procedure in all patients undergoing radical prostatectomy.

Original languageEnglish
Article number79
JournalBMC Urology
Issue number1
Publication statusPublished - 2015 Aug 1

Bibliographical note

Publisher Copyright:
© 2015 Kwon et al.

All Science Journal Classification (ASJC) codes

  • Reproductive Medicine
  • Urology


Dive into the research topics of 'Oncologic outcomes in men with metastasis to the prostatic anterior fat pad lymph nodes: A multi-institution international study'. Together they form a unique fingerprint.

Cite this