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Should Anterior Prostatic Fat During Radical Prostatectomy Undergo Pathological Examination?
Brooke A Harnisch1, Kevin Tomera2, Ingolf A Tuerk2
1Boston University School of Medicine and Boston Medical Center, Boston, MA;2St. Elizabeth's Medical Center, Brighton, MA

Introduction:
Dissection of the anterior fat overlying the prostate allows for visualization during robotic prostatectomy. However, this fat is usually not sent for pathologic analysis. One study has demonstrated that anterior prostatic fat (APF) can harbor lymph nodes involved with prostate cancer. Therefore, the purpose of this study was to evaluate APF and the incidence for positive nodes.
Methods:
An IRB approved retrospective study was conducted on patients who underwent robotic prostatectomy and had APF sent for pathologic analysis. Clinical and pathological data was analyzed.
Results:
101 patients were identified. Mean age was 57 +/- 8.3 years. 9/101 patients (8.9%) had APF lymph nodes. A total of ten lymph nodes were found (range 1-2). Overall, 2/101 patients (2%) had positive APF nodes despite negative lateral nodes. The pre-operative biopsy Gleason score and prostate specific antigen was 4+3 and 5.5 ng/ml for patient 1 and 4+3 and 2.6 ng/ml for patient 2. BMI didn't differ among patients with and without APF nodes 27.8 + 2.4 vs. 27.9 + 3.6 ( kg/m2 + SD). Final pathological data is summarized in Table 1.
Conclusions:
APF lymph nodes were positive for metastatic prostate cancer in 2% of patients despite having negative lateral pelvic lymph nodes. Ultimately, this finding lead to pathological upstaging stressing the importance of examining this specimen.
Table 1. Final pathological data for patients with positive APF nodes

Seminal vesicle invasionExtraprostatic extensionPerineural invasionLymphovascular invasionPositive lateral pelvic lymph nodesPathological staging
Patient one(-)(-)(+)(-)NopT3a
N1Mx
Patient
two
(-)(-)(+)(+)NopT2c
N1Mx


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