EAU 2017: Extended pelvic lymph node dissection for intermediate-high risk prostate cancer: Frequency and distribution of nodal metastases

London, England (UroToday.com) Understanding lymphatic spread of prostate cancer to the pelvic and regional lymph nodes remains an important assessment to help guide the discussion on extent of lymphadenectomy. As such, the authors utilize their experience with extended and superextended lymph node dissection to describe the lymphatic spread of prostate cancer in patients with clinically localized, intermediate-high risk prostate cancer (PCa) treated with radical prostatectomy (RP) and ePLND.

In this singe-institution retrospective study, the authors retrospectively evaluated 554 consecutively treated men between 2009 and 2015. Extended PLND was always completed, and consisted of the external iliac, obturator, internal iliac, presacral and common iliac nodal site up to the ureteric crossing, with specimens being sent as separate packets. 

Median number of nodes removed was 22 (range 9-61). Of the 554 patients, pathologic node disease was found in 119 patients (21.4%) of men, including superextended node dissection. Comparing ePLND vs. standard PLND: standard PLND correctly staged 77% of patients and cleared tumor burden in 31%, while ePLND correctly staged 97% and cleared 78% of tumor burden (compared to superextended).

From a drainage standpoint, key points made by the authors were as follows: Internal iliac and presacral nodes harbored metastases in more than 60% of cases, and positive nodes were present only in these areas in 23% of cases. On the contrary, metastases at common iliac nodes were always associated with concomitant involvement of external iliac, obturator and/or internal iliac nodes.

Limitations / Discussion / Future Directions:

1. They plan on doing further subset analyses of intermediate and high-risk patients. At this time, that information is unavailable.
2. During question session, it was noted by the authors that of the 119 patients who were pN+, 20% had symptomatic lymphocele. Uncertain what this percentage was in the entire cohort. Also, no specifics on lymphedema.

Presented by: Marco Roscigno

Co-Authors: Nicolai M., Naspro R., Pellucchi F., Cornaghi L.B., Angiolilli D., Chinaglia D., Da Pozzo L.F.

1. ASST Papa Giovanni XXIII, Dept. of Urology, Bergamo, Italy, 
2. ASST Papa Giovanni XXIII, Dept. of Pathology, Bergamo, Italy

Written by: Thenappan Chandrasekar (Clinical Fellow, University of Toronto

at the #EAU17 -March 24-28, 2017- London, England