Indications and Trends in Pelvic Lymph Node Dissection for Prostate Cancer

Bob Djavan, Amir Kazzazi, Lori Dulabon, Shabnam Momtahen, Seyed Saeid Dianat, Matthew Sand, Philippa Cheetham, Gunter Janetschek, Herbert Lepor, Markus Graefen

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations

Abstract

Context: Controversy persists concerning the role of pelvic lymph node dissection (PLND) in patients with clinically localized prostate cancer (PCa) undergoing radical prostatectomy (RP). Objective: The aim of this review is to critically evaluate the current status of PLND in PCa. Evidence acquisition: A review of the literature was performed concerning RP and PLND with respect to oncologic outcome and associated complications. Evidence synthesis: PLND is still the modality of choice for detecting lymph node metastasis in PCa, as current imaging techniques are not accurate enough for detecting nodal metastases. Extended PLND (ePLND) has complications that increase with extent of dissection. Nodal yield at PLND is directly related to the lymph node invasion rate, and greater nodal yield is associated with superior staging accuracy. Conclusions: For patients with high- and intermediate-risk disease, ePLND-at least for external iliac, obturator, and hypogastric lymph nodes-should be performed during RP. However, for patients with low-risk disease, PLND is neither necessary nor recommended, because the chance of metastasis is low. In high-risk patients, the extent of PLND is controversial and should be the subject of more trials to determine long-term therapeutic benefit. Controversy persists concerning the role of pelvic lymph node dissection (PLND) in patients with clinically localized prostate cancer undergoing radical prostatectomy. In high- and intermediate-risk disease, extended PLND should be performed, at least for specific lymph nodes. However, for patients with low-risk disease, PLND is neither necessary nor recommended because the chance of metastasis is low.

Original languageEnglish
Pages (from-to)e38-e43
JournalEuropean Urology, Supplements
Volume10
Issue number3
DOIs
StatePublished - May 2011
Externally publishedYes

Keywords

  • Frozen section
  • Localized prostate cancer
  • Lymph node metastasis
  • Pelvic lymph node dissection
  • Radical prostatectomy

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