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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Urology 1/2015

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

BMC Urology > Ausgabe 1/2015
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 Eun, Varsha 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
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12894-015-0070-1) contains supplementary material, which is available to authorized users.
Young Suk Kwon and Yun-Sok Ha contributed equally to this work.

Competing interests

None of the contributing authors have any conflicts of interest, including specific financial interests and relationships and affiliation relevant to the subject matter or materials discussed in the manuscript.

Authors’ contributions

YSK and YSH reviewed the pertinent literature, analyzed the results, and drafted and edited the manuscript. IYK was responsible for the entire project. He designed the study concept, guided the study design, conducted data acquisition, and revised the manuscript critically for important intellectual content. PKM, AS, JSP, NP, IF, MM, DIL, EL, TP, KHR, TA, DS, HA, SKC, SP, SSJ, YCO, DE, VM, DA, KB, BY, NR, THK, TGK, DM, JH, and WJK collected data, analyzed data, and revised the manuscript. All authors read and approved the final manuscript.



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.


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).


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.


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.
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