Extent of Lymphadenectomy at Time of Prostatectomy: An Evidence-Based Approach

Pelvic lymph node dissection (PLND) at the time of radical prostatectomy is the most accurate method of lymph node staging in prostate cancer. Although there are varied practices in anatomic extent of PLND, evidence favors an extended PLND (ePLND) including external iliac, obdurator, and internal iliac nodes. Removing presacral and/or common iliac nodes to the ureteric crossing can improve staging. The oncologic benefits of extended dissection are unclear based on methodologic limitations and bias in the available evidence. Diverse nomograms may clarify which patients warrant ePLND. Higher level evidence is needed to clarify the therapeutic effects of ePLND and who benefits most.