Men with a higher percentage of positive prostate biopsy cores have greater likelihood of pelvic lymph node involvement (LNI) with prostate cancer, according to new study findings presented during the virtual 2021 Genitourinary Cancers Symposium.

Using the National Cancer Database, investigators identified 109,577 patients diagnosed with cN0M0 prostate cancer who had 6 to 24 cores sampled at biopsy and subsequently underwent radical prostatectomy with pathologic nodal evaluation. A total of 4340 (4.0%) of the cohort were found to have pelvic LNI at surgery.

Having 25.1-50.0%, 50.1-75.0%, or 75.1-100.0% of biopsy cores positive for prostate cancer significantly correlated with a 1.8-, 2.6-, and 4.5-fold increased risk of pelvic LNI, respectively, David Dewei Yang, MD, of the Harvard Radiation Oncology Program in Boston, Massachusetts, and colleagues reported.

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Among men with Gleason 9-10 disease, those with 75.1 to 100.0% of prostate biopsy cores positive had a 32.6% risk for pelvic LNI, whereas those with 25.0% or fewer biopsy cores positive had a lower 8.6% risk for LNI.

Traditional risk factors also increased the likelihood of pelvic LNI. A higher biopsy Gleason score of 8 or 9-10 was significantly associated with a 1.4- and 2.8-fold higher risk for LNI, respectively, compared with biopsy Gleason 4+3. Likewise, as clinical tumor stage increased, the risk for LNI significantly increased by 1.5-, 2.0-, and 3.9-fold for cT2, cT3, and cT4, respectively, compared with cT1. Higher PSA also portended significantly higher risk for LNI by 1.9-, 2.4-, and 2.6-fold for a PSA of 10.0-19.9 ng/mL, 20.0-39.9 ng/mL, and 40.0 ng/mL or higher, respectively, compared with a PSA of less than 10.0 ng/mL. No significantly increased risks for LNI were found for older or Black men.

According to Dr Yang’s team, “clinicians should consider incorporating information on [positive prostate biopsy cores] in determining which patients with prostate cancer may benefit from receiving radiation therapy to the pelvic lymph nodes.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Yang DD, Dee EC, Arega MA, et al. Association between percentage of positive biopsy cores and risk of pelvic lymph node involvement in prostate cancer. Paper presented at: 2021 Genitourinary (GU) Cancers Symposium; February 2021. Abstract 205.