EURURO Vol. 72 No. 2

E36 320

Letter to the Editor
Re: Rodolfo Montironi, Silvia Gasparrini,
Roberta Mazzucchelli, et al’s Letter to the Editor re:
Karim A. Touijer, James A. Eastham. The Sentinel Lymph
Node Concept and Novel Approaches in Detecting
Lymph Node Metastasis in Prostate Cancer. Eur Urol
2016;70:738-9: Sentinel Lymph Nodes in Adipose Tissue
Surrounding the Prostate Gland and Seminal Vesicles as
Observed in Virtual Whole-mount Histologic Slides.
Eur Urol 2017;71:e73–5
I read with interest the letter by Montironi et al
commenting on the paper by Touijer and Eastham on the
concept of sentinel lymph nodes of the prostate. Certainly
these have not been recognized in prostate cancer to the
extent they have in other malignancies.
As a urologic anatomic pathologist, I have noted lymph
nodes in periprostatic fat in a very small percentage of cases.
Curiously, the frequency of such nodes has been reported as
<1% , 1% , 4% , and 17% , suggesting that the
frequency depends highly on the technique of the surgeon(s)
for the population being studied. The percentage of
prostatectomy tissue submitted probably also influences
the frequency: alternate slices versus selected sections versus
submission in toto, which may vary from institution to
institution and may also depend on the specimen (eg, many
laboratories favor partial submission for larger prostates).
Surgical technique is variable, but it does seem that most
urologists include the periprostatic fat in the prostatectomy
specimen submitted. My brief survey of ten urologists from
five academic centers indicated that nine always include the
fat, one includes the fat only for nerve-sacrificing surgery,
and one discards the fat. Seven use a robotic approach and
three use an open approach.
At the very least, the possibility of finding lymph nodes
in this fat suggests the value of not discarding it, and of
submitting the entire prostate whenever biopsy has shown
high-grade or high-volume tumor. More studies are needed
regarding the frequency and prognostic implications of
periprostatic lymph nodes to confirm they have a higher
metastatic rate than obturator and other pelvic lymph
nodes typically sampled at radical prostatectomy. The latter
might confirm a tendency of lymphatic drainage to be
stepwise and unidirectional.
Conflicts of interest: The author has nothing to disclose.
References
[1]
[2]
[3]
[4]
[5]
Kenneth A. Iczkowski*
Pathology Department, Medical College of Wisconsin, Milwaukee, WI, USA
*Pathology Department, Medical College of Wisconsin, 9200 W.
Wisconsin Avenue, Milwaukee, WI 53226, USA. Tel. +1 414 8058463;
Fax: +1 414 8058463.
E-mail address:
February 22, 2017
available at
journal homepage:
DOIs of original articles: .
0302-2838/# 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.