Therapeutic approaches for lymph node involvement in prostate, bladder and kidney cancer

Introduction: A considerable proportion of patients are still found with nodal involvement when considering prostate (PCa), bladder (BCa) and renal cancer (RCC). This scenario is often related to poorer oncological outcomes, but evidence supporting this correlation remain scarce or controversial. Areas covered: A review was conducted to provide updated evidence in the field of pathological nodal involvement in PCa, BCa, and RCC. Nodal-staging process, role of lymphadenectomy and available therapeutic strategies were covered. Expert opinion: Nodal staging mostly relies on CT scan. FDG-PET for BCa and RCC and PSMA-PET for PCa have shown promising results, although some issues like availability and cost-effectiveness still need to be addressed. For PCa, pre-operative nomograms have almost completely replaced the need for imaging with nodal staging purposes. Still, the gold standard remains lymphadenectomy. The oncological benefit of LND is still not clear for PCa and RCC but is related to a better oncological outcome for BCa. For PCa the use of androgen deprivation therapy combined with radiotherapy, particularly in men with high risk of local recurrence, is supported. For BCa, the use of adjuvant chemotherapy is suggested. In regards to RCC, the oncological benefit of adjuvant therapies is still unclear.