Is extended pelvic lymph node dissection for prostate cancer the only recommended option? A systematic over-view of the literature

Pelvic lymph node dissection (PLND) is performed alongside radical prostatectomy as the most accurate method of staging prostate cancer. Yet the potential therapeutic benefits of lymphadenectomy are yet to be confirmed.

A PubMed database search was performed to identify all papers comparing techniques for PLND or none. The primary outcome measure was long term oncological outcomes. Studies looking at men with clinically localized prostate cancer at the time of radical prostatectomy who received no adjuvant treatment were included. Previous reviews and single case reports were excluded. The subsequent available papers were then systematically reviewed.

Limited PLND provides no benefit in low risk prostate cancer and is unlikely to provide a therapeutic benefit in higher risk groups either when compared with no PLND. Extended PLND may provide some therapeutic benefit, particularly in patients with occult metastases; however, the evidence base for this is not particularly strong and may be down to statistical phenomena.

When performed in prostate cancer patients, PLND should be extended, as it is a more accurate staging tool and may provide therapeutic benefit to some patients. However, to properly assess this, randomised controlled studies need to be performed in this area.

Turkish journal of urology. 2016 Dec [Epub]

Thomas Rees, Nicholas Raison, Mohammed Iqbal Sheikh, Zahra Jaffry, Sanjeev Madaan, Ben Challacombe, Kamran Ahmed, Prokar Dasgupta

King's College School of Medicine, King's College London, London, UK., MRC Centre for Transplantation, Kings College London, London, UK., Department of Urology, Medway Maritime Hospital, Gillingham, UK., Department of Urology, Guy's and St Thomas' Hospital, London, UK., Department of Urology, Darent Valley Hospital, Dartford, UK.