Pelvic lymph node management in prostate cancer: a narrative review

Area of Science:

• Urology
• Oncology
• Radiology

Background:

• Pelvic lymph node management is critical for staging and treating early prostate cancer, particularly in high-risk individuals.
• Current management strategies involve a range of techniques with varying degrees of invasiveness and efficacy.

Purpose of the Study:

• To review current practices and emerging techniques in pelvic lymph node management for early prostate cancer.
• To highlight advancements in imaging, surgical procedures, and radiotherapy.

Main Methods:

• Narrative review of current literature on pelvic lymph node management.
• Exploration of advanced imaging (PSMA PET/CT), surgical techniques (PLND, sentinel lymph node biopsy, radioguided surgery, ePLND), and radiotherapeutic strategies.

Main Results:

• Prostate-specific membrane antigen (PSMA) PET/CT significantly improves nodal staging accuracy over conventional methods.
• Pelvic lymph node dissection (PLND) is the gold standard but carries significant morbidity; less invasive techniques show promise.
• Extended PLND and advanced radiotherapy offer potential benefits for selected patients.

Conclusions:

• The field of pelvic lymph node management is evolving towards personalized approaches integrating molecular imaging and new technologies.
• Standardization and comparative studies are needed to optimize outcomes for prostate cancer patients.