Metastatic Involvement of the Prostatic Anterior Fat Pad: Implications for the Pathologist

• Published in: American journal of clinical pathology Vol. 150; no. 2; pp. 130 - 136
• Main Authors: Lopez-Hisijos, Nicolas, Genco, Iskender, Gorbonos, Alex, Pambuccian, Stefan E, Barkan, Güliz Akdas
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 03-07-2018
• Subjects: Adipose Tissue - pathology; Aged; Cancer surgery; Humans; Lymph Node Excision - methods; Lymph nodes; Lymphatic Metastasis - diagnosis; Lymphatic Metastasis - pathology; Lymphatic system; Male; Metastases; Metastasis; Middle Aged; Neoplasm Staging - methods; Pathologists; Prostate cancer; Prostatectomy; Prostatic Neoplasms - pathology; Retrospective Studies; Urological surgery
• ISSN: 0002-9173; 1943-7722
• DOI: 10.1093/AJCP/AQY048

There is little information regarding the utility of pathologic evaluation of the prostatic anterior fat pad (PAFP) in patients with a low preoperative probability of recurrence. Our study aimed to determine the utility of PAFP pathologic examination, especially for this group of patients.
We analyzed a tertiary care academic center's radical prostatectomy (RP) specimens from 2009 to 2017.
Of 602 RP specimens, 420(70%) included the PAFP; four of 420 (1%) had lymph node involvement (LNI) in the PAFP. In two of four cases with LNI in the PAFP, this was the only site of LNI. Of these two cases, one occurred in a patient with low probability of recurrence and involved a nonpalpable PAFP lymph node.
Pathologic evaluation of the PAFP may be useful even in patients with low probability of recurrence because it may change staging by detecting metastatic involvement of small PAFP lymph nodes.