[It is unclear whether pelvic lymphadenectomy is of oncological benefit in prostate cancer]

Fossati's 2017 review questions the value of pelvic lymphadenectomy (pLA) in radical prostatectomy (RP) because available studies fail to show any oncological benefit. Our finding that no spread of metastatic lymph nodes (LN) has been demonstrated is based on registry data, clinical trials without evidence of pLA benefit and considerations of the genetic link between LN metastasis and distant metastases. The improved imaging with ⁶⁸GaPSMA-PET-CT facilitates the detection of metastases and thus the omission of pLA as diagnostic intervention, thereby avoiding typical complications. The question whether pLA, or a multimodal treatment concept, might benefit intermediate and high-risk patients can only be answered by an RCT which, above all, must consider the incompletely removed primary as a source of metastatic spread.