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The role of pelvic lymphadenectomy for prostate cancer--therapeutic?
M Wagner1, M Sokoloff, S Daneshmand
1Section of Urologic Oncology, Division of Urology and Renal Transplantation, Oregon Health and Sciences University, Portland, Oregon, USA.
Purpose:
The incidence of metastatic lymph node involvement in prostate cancer has decreased with the advent of prostate specific antigen testing. Various algorithms have been designed to assess the probability of lymphatic involvement, resulting in the omission of lymph node dissection in many cases. However, recent reports suggest an underestimation of lymph node involvement. Meticulous lymph node dissection may provide a survival benefit by addressing micrometastatic disease. We analyzed the current literature on extended pelvic lymphadenectomy in prostate cancer.
Material And Methods:
The pelvic lymphadenectomy literature was reviewed using a MEDLINE search, focusing on the prevalence of positive nodes, staging vs extended lymphadenectomy and therapeutic benefits.
Results:
Staging pelvic lymphadenectomy provides valuable prognostic data and it may be therapeutic. Extended lymph node dissection increases the detection of positive nodes. The number of positive or negative nodes resected may increase survival. The observed survival benefits may be due to the elimination of micrometastatic disease.
Conclusions:
The role, indications and extent of lymphadenectomy remain controversial. Extended lymph node dissection should be performed in all patients at high risk to increase staging accuracy and provide a potential survival benefit. Detailed, meticulous dissection of the internal iliac lymph tissue is required. The benefit of extended lymph node dissection in patients at low risk remains to be determined.