It is generally agreed upon that extended pelvic lymph-node dissection (ePLND) provides valuable staging information and helps guide adjuvant therapy, and should be undertaken in prostate cancer (CaP) patients with aggressive preoperative disease features at the time of radical prostatectomy [1, 2]. However, whether it has a 'direct' therapeutic benefit in the aforesaid patients has remained difficult to demonstrate . The only patients that seem to derive a survival advantage from ePLND are patients with pN1 disease  - this cited study suggested a direct therapeutic effect of ePLND, with a 7% incremental benefit in 10-year cancer-specific survival per every additional lymph-node removed (p=0.02). However, it did not identify these patients preoperatively.
BJU international. 2020 Feb 11 [Epub ahead of print]
Akshay Sood, Jacob Keeley, Isaac Palma-Zamora, Deepansh Dalela, Sohrab Arora, James O Peabody, Craig G Rogers, Francesco Montorsi, Mani Menon, Alberto Briganti, Firas Abdollah
VCORE - Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI., Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.