Limited versus Extended Pelvic Lymph Node Dissection for Prostate Cancer: A Randomized Clinical Trial

Area of Science:

• Urology
• Oncology
• Surgical Oncology

Background:

• Pelvic lymph node dissection (PLND) is crucial for staging prostate cancer, but its therapeutic benefit and optimal extent are debated.
• While common in radical prostatectomies, there's no consensus on the ideal anatomical scope of PLND.

Purpose of the Study:

• To determine if extended pelvic lymph node dissection (PLND) leads to a lower biochemical recurrence rate in prostate cancer patients.
• Evaluating the impact of extended PLND on oncological outcomes.

Main Methods:

• A single-center randomized trial involving 1440 patients undergoing radical prostatectomy and PLND.
• Patients were cluster-randomized to either limited (external iliac nodes) or extended (external iliac, obturator, hypogastric nodes) PLND.
• Primary endpoint was biochemical recurrence, with median follow-up of 3.1 years.

Main Results:

• No significant difference in biochemical recurrence rates between limited and extended PLND groups (HR 1.04, p=0.5).
• Median retrieved nodes: 12 (limited) vs. 14 (extended); positive node rates: 12% vs. 14%.
• Similar rates of grade 2 and 3 complications (7.3% vs. 6.4%); no grade 4 or 5 complications.

Conclusions:

• Extended PLND did not improve freedom from biochemical recurrence compared to limited PLND in localized prostate cancer.
• Observed differences in nodal yield and positive node rates were smaller than anticipated.
• A randomized trial comparing PLND to no node dissection is warranted.