[Sentinel lymph node dissection for localized prostate cancer]

Proper assessment of lymph node status is of crucial importance in the management of newly diagnosed prostate cancer. Early stage metastatic disease takes the form of microscopic tumor-cell deposits rather than grossly enlarged nodes. So far there is no imaging technique, however, which allows detecting small metastases in the range of a few millimetres. Therefore pelvic lymph node dissection (PLND) is the only reliable method of staging for clinically localized prostate cancer. The cornerstone of radioguided prostate surgery is a radiopharmaceutical--a carrier molecule labeled by radionuclide. After injection to at the prostate, the radiopharmaceutical crosses the lymphatic pores and migrates into the lymph vessels and from there to the first echelon of lymph nodes. We were the first to show that sentinel PLND can be performed by means of laparoscopy preceding laparoscopic radical prostatectomy. Our most recent publication presents data of 140 patients with clinically localized prostate cancer in which laparoscopic sentinel PLND was performed preceding radical prostatectomy from November 2001 to January 2005. On the preoperative scintigraphy SLNs were detected bilaterally,unilaterally, not on the pelvic-walls in 113 (80.7%), 20 (14.2%) and 6 (4.2%) patients and intraoperatively in 96 (68.6%), 36 (25.7%), 8 (5.7%) patients respectively. In 99 out of 140 patients (70.7%) intraoperatively SLN was detected in the same position as on preoperative scan. At least one SLN was detected in 133 patients (95.3%). Whenever PLND is indicated it should not be limited to lymph node sampling as provided by standard limited PLND but has to be performed in the template of extended PLND. There is only limited experience with sentinel PLND, but all the data collected so far indicate that this method has the potential to become an alternative to extended PLND since it allows for reduction of the extent of PLND without compromising diagnostic accuracy.