The Role of Pelvic Lymphadenectomy for Prostate Cancer—Therapeutic?

Purpose

The incidence of metastatic lymph node involvement in prostate cancer has decreased with the advent of prostate specific antigen testing. Various algorithms have been designed to assess the probability of lymphatic involvement, resulting in the omission of lymph node dissection in many cases. However, recent reports suggest an underestimation of lymph node involvement. Meticulous lymph node dissection may provide a survival benefit by addressing micrometastatic disease. We analyzed the current literature on extended pelvic lymphadenectomy in prostate cancer.

Material and Methods

The pelvic lymphadenectomy literature was reviewed using a MEDLINE® search, focusing on the prevalence of positive nodes, staging vs extended lymphadenectomy and therapeutic benefits.

Results

Staging pelvic lymphadenectomy provides valuable prognostic data and it may be therapeutic. Extended lymph node dissection increases the detection of positive nodes. The number of positive or negative nodes resected may increase survival. The observed survival benefits may be due to the elimination of micrometastatic disease.

Conclusions

The role, indications and extent of lymphadenectomy remain controversial. Extended lymph node dissection should be performed in all patients at high risk to increase staging accuracy and provide a potential survival benefit. Detailed, meticulous dissection of the internal iliac lymph tissue is required. The benefit of extended lymph node dissection in patients at low risk remains to be determined.

Key Words: prostate, prostatic neoplasms, lymph node excision, risk, neoplasm staging

Abbreviations and Acronyms: MRI, magnetic resonance imaging, PSA, prostate specific antigen