Extended pelvic lymphadenectomy in men undergoing radical prostatectomy - an update on > 300 cases

Pelvic nodal dose escalation with prostate hypofractionation using conformal avoidance defined (H-CAD) intensity modulated radiation therapy

“…Tables [4] and formulas [5] employing clinical parameters have been commonly used to estimate the risk of lymph node disease, butemerging data based upon more comprehensive lymph node dissections suggest that these calculated risks of lymph node metastases may be underestimated [22,23]. These data suggest that a greater than previously appreciated proportion of PSA failures in post-prostatectomy or ''prostate-only'' RT patients (external beam or brachytherapy) may be due to unaddressed disease within the pelvic lymph nodes.…”

Extended lymph node dissection for prostate cancer

“…The CART analysis also shows a weak reliability regarding its predictive accuracy for LN metastasis [7,8]. Some correlation was noted in the high-risk group, but significant differences were seen between the predicted and actual frequencies of LN metastasis following ePLND in the low-risk (predicted, 2.2%; actual, 17%) and intermediate-risk (predicted, 19.4%; actual, 46%) groups.…”

“…Heidenreich et al [7,8] analyzed the predictive accuracy of Partin tables and classification and regression tree (CART) analysis in patients undergoing RP and ePLND. A good correlation between predicted LN positivity and actual LN metastasis was found in the very low-risk group of patients with cT1c, Gleason score 2-4, and PSA < 10 ng/mL, with no LN metastases detected.…”

Improving the surgical treatment of high-risk localised or locally advanced prostate cancer

“…Large-scale studies on limited LND report LNI rates of 2-3.7%, [15][16][17] which compares with the rate of 11-26% in ePLND studies. [18][19][20] It is generally accepted that the eLND provides important staging information, but there is no consensus regarding the absolute indications for eLND. 2 The European Association of Urology guidelines recommend that eLND is not necessary in low-risk localised prostate cancer, where the risk of lymph node involvement does not exceed 5%.…”

“…23 eLND increases the morbidity associated with prostate cancer treatment: a number of studies have reported a higher rate of complications compared with limited LND, [24][25][26] while others have reported no increase. 18,27 Complications include lymphocoele, lymphoedema, deep venous thrombosis and a higher rate of pulmonary embolism.…”