Pelvic lymphadenectomy for localized prostate cancer

In the era of prostate specific antigen, there is increasing proportion of patients with localized prostate cancer. Accurate preoperative determination of lymph node status is important for adequate selection of treatment option, monitoring of response to treatment and early detection of recurrence. Lymph node invasion (LNI) is crucial prognostic parameter for patients who underwent curative treatment. Despite of continuous improvments of radiological armamentarium, CT, MRI and PET scans are not absolutely reliable in lymph node staging. Many nomograms have been developed for prediction of lymph node status, but accuracy of these statistical models is not better than 78%. Surgery, either open or laparoscopic pelvic lymphadenectmy (PLND), remains a cornerstone in lymph node staging. However, there are several controversies regarding PLND 1) necessity for routine perfoming in each patient, 2) anatomic boundaries for PLND, 3) morbidity of PLND, and 4) diagnostic and therapeutic value.