Current status of pelvic lymph node dissection in prostate cancer

Pelvic lymph node dissection (PLND) is presently considered the gold standard for the detection of lymph node invasion in prostate cancer (PCa) patients. Controversy exists over the adequate extent of PLND for patients at different stages of PCa and over the therapeutic value of the procedure. The most recent consensus advocates extended PLND (ePLND) in a patient with Gleason score ≥7 and serum prostate-specific antigen >10 ng/ml who is undergoing radical prostatectomy. Critics claim more aggressive dissection is associated with an increase in complications, hospitalization time, and cost. The present review examines the debate of limited versus ePLND, and discusses the potential value of the latter for patients with PCa. Furthermore, it examines the utility of robotic-assisted surgery in performing PLNDs with both comparable oncological outcomes and comparable complication rates. The literature has reported promising results that support both diagnostic and therapeutic benefits of ePLND. However, prospective, multi-center, long-term studies are necessary to alleviate criticism of the increased risk of complications and costs of performing PLND.