To compare perioperative and early oncological outcomes of robotic radical prostatectomy (RP) with and without extended pelvic lymph node dissection (PLND) in a cohort of intermediate (IR)-to-high-risk (HR) prostate cancer (PCa) patients.
Data was prospectively collected from 88 patients (47 PLND, 41 no-PLND) with unfavorable intermediate- and high-risk miN0M0 PCa, all staged preoperatively with PSMA-PET/CT. Outcomes were assessed using Kaplan-Meier curves, uni-and multivariable Cox regression, for biochemical recurrence-free survival (BCRFS) and biochemical failure-free survival (BCFFS). A propensity score matched analysis with Cox regression was undertaken matching 1:1 for potential confounders (age, iPSA, preoperative ISUP, cT stage at MRI).
Both groups (PLND and no-PLND) had the same proportion of HR patients (p = 1.0). The no-PLND group had a shorter median operative time by 50 min (p < 0.01). Conversely, the PLND group experienced significantly higher rates of 90-day high-grade complications (p = 0.03) and lymphoceles (p < 0.01). Over a median 20.5-month follow-up, no significant differences emerged in BCRFS (p = 0.59) or BCFFS (p = 0.76). Uni- and multivariable analyses adjusted for UCSF CAPRA and CAPRA-S variables, as well as propensity score matching, confirmed PLND was not associated with improved BCFFS. In patients who did recur, the sites of recurrence did not differ between the two groups (p = 0.62), with pelvic nodal recurrence being the most common site of recurrence in both groups (6, 50% for PLND and 3, 60% for no-PLND).
In this short-term follow-up, performing PLND increased high-grade postoperative complications without providing a clear early oncological benefit regarding BCRFS, PSA persistence, or recurrence location.
World journal of urology. 2026 Mar 11*** epublish ***
Giuseppe Reitano, R Jeffrey Karnes, Giacomo Novara, Daniel S Roberson, Mohamed E Ahmed, Filippo Carletti, Umar Ghaffar, Giuseppe Dinoi, Salvatore Carrozza, Maurizio Bentivoglio, Simone Botti, Carlo Prevato, Giovanni Betto, Fabio Zattoni, Fabrizio Dal Moro
Department of Surgery, Oncology and Gastroenterology, Università Padova, 35128, Padova, PD, Italy., Department of Urology, Mayo Clinic, 55905, Rochester, MN, USA., Urology Unit, Azienda Ospedale Università Padova, 35126, Padova, PD, Italy., Department of Surgery, Oncology and Gastroenterology, Università Padova, 35128, Padova, PD, Italy. .