Impact of extent of lymphadenectomy on survival after radical prostatectomy for prostate cancer

Joslyn, Sue A.; Konety, Badrinath R.

doi:10.1016/j.urology.2006.01.055

Cited by 257 publications

(165 citation statements)

References 18 publications

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“…The accuracy of staging based on the number of lymph nodes removed appears to relate to not only the completeness of lymph node dissection but also interindividual variation [46]. PLND studies on bladder and prostate cancers have clearly demonstrated a significant correlation between the number of lymph nodes removed and the presence of lymph node metastases [18,20,23,47]. Although the minimum number of lymph nodes required for optimal staging still remains unknown, because of the interindividual variation in lymph node count, it is probably more important to clear a certain template (extended PLND) and submit the lymph nodes in separate packets for histological assessment than to focus only on the number of lymph nodes retrieved.…”

Section: Plnd Influence On Staging and Survivalmentioning

confidence: 99%

“…Joslyn et al [18], as seen in bladder cancer, showed that the presence of two or more prostate cancer lymph node metastases conferred a greater risk for cancer-related death than a solitary metastasis. Recently, Boorjian and colleagues retrospectively reviewed a large series of patients from the Mayo Clinic with positive lymph nodes with or without adjuvant hormonal therapy, in which 56% and 86% of the lymph node-positive patients had a 10-year biochemical progression-free survival and cancer specific survival duration, respectively [62].…”

Section: Prostate Cancermentioning

confidence: 99%

“…It was shown that, even by removing Ն11 negative lymph nodes, the 5-year survival rate was approximately 50%, compared with the 20% rate seen in those who had Ͻ11 negative nodes dissected. Based on the analysis of the Surveillance, Epidemiology, and End Results program database in 1,923 patients, Josyln and colleagues also concluded that an extended PLND reduced the long-term risk for prostate cancer-related death, even in patients with negative nodes, compared with those who had no PLND [18].…”

Section: Prostate Cancermentioning

confidence: 99%

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Indications, Extent, and Benefits of Pelvic Lymph Node Dissection for Patients with Bladder and Prostate Cancer

2009

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Target audience: Physicians who wish to advance their current knowledge of clinical cancer medicine in genitourinary cancer. LEARNING OBJECTIVES1. Evaluate all patients undergoing radical pelvic surgery to determine whether they should have pelvic lymph node dissection.2. Determine to what extent a pelvic lymph node dissection should be performed and analyze the risks involved.3. Based on best practices, assess whether pelvic lymph node dissection is beneficial for staging and prognosis.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTThe role of pelvic lymph node dissection (PLND) in both bladder and prostate cancer has recently been generating renewed interest. In an attempt to avoid PLND, both nomograms and imaging studies have been evaluated; however, so far they have shown limited success because of inadequate accuracy in staging patients. The three primary objectives of this review are: to define patients in whom PLND should be performed, to define the extent and consequences of the template for PLND, and to identify the staging and prognostic benefits seen with PLND in bladder and prostate cancer. Based on the findings from this review, we conclude that PLND for bladder cancer patients is undoubtedly beneficial, whereas it is less so for prostate cancer patients, in whom a selection strategy should be employed. PLND, in particular with an extended template, seems to provide superior accuracy for postoperative staging than the presently available imaging studies and may be pivotal when considering adjuvant therapies. Furthermore, it has an impact on survival in high-risk patients, and potentially more so in low-risk cancer patients with occult metastases.

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Section: Plnd Influence On Staging and Survivalmentioning

confidence: 99%

Section: Prostate Cancermentioning

confidence: 99%

Section: Prostate Cancermentioning

confidence: 99%

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Indications, Extent, and Benefits of Pelvic Lymph Node Dissection for Patients with Bladder and Prostate Cancer

2009

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“…In addition, a therapeutic and cancer-specific survival benefit may occur after PLND. [1][2][3][4] With the rise of the prostate-specific antigen (PSA) era, a downward stage migration resulting from the earlier detection of prostate cancer has led to a decreased incidence of positive LNs. [20][21][22] To determine who should undergo a PLND, the benefits must be weighed against the associated comorbidities and applied to those who are at risk of metastatic disease.…”

Section: Who Should Undergo Plnd?mentioning

confidence: 99%

“…Some believe that PLND is therapeutic and promotes a cancer-specific survival benefit. [1][2][3][4] This review aims to critically analyze: (1) the anatomy of the prostate gland's lymphatic drainage, (2) the anatomic boundaries of PLND and which dissection may be superior, (3) who should undergo a PLND during prostatectomy, (4) the potential therapeutic benefits of performing PLND and (5) the complications of PLND. …”

mentioning

confidence: 99%

Pelvic lymphadenectomy in prostate cancer

Breyer

Greene

Dall′Era

et al. 2008

Prostate Cancer Prostatic Dis

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This review analyzes the anatomy of the prostate gland's lymphatic drainage, the optimal anatomic extend of pelvic lymph node dissection (PLND) and which dissection may be superior, who should undergo a PLND during prostatectomy, and its potential therapeutic benefits and complications. The prostate gland's lymphatic drainage can be variable, but frequently metastatic disease is found in the internal iliac chain. We conclude that the extended PLND yields the most lymph nodes and therefore may be superior. Some have demonstrated an unproven survival benefit after performing an extended PLND, possibly from removal of occult disease or from more accurate staging.Prostate Cancer and Prostatic Diseases (2008) 11, 320-324; doi:10.1038/pcan.2008 published online 20 May 2008 Keywords: pelvic lymph node dissection; lymph nodes; anatomy; radical retropubic prostatectomyThe role of pelvic lymph node dissection (PLND) during radical prostatectomy has generated considerable debate. The central role of a PLND is to determine the locoregional extent of cancer, and to help evaluate the need for adjuvant therapy and the risk of progression and recurrence. Some believe that PLND is therapeutic and promotes a cancer-specific survival benefit. [1][2][3][4] This review aims to critically analyze: (1) the anatomy of the prostate gland's lymphatic drainage, (2) the anatomic boundaries of PLND and which dissection may be superior, (3) who should undergo a PLND during prostatectomy, (4) the potential therapeutic benefits of performing PLND and (5) the complications of PLND. PLND anatomically definedAnatomic studies have been performed to define the periprostatic subcapsular lymphatic network that drains the prostate. 5,6 The network is composed of the ascending, lateral and posterior groups. The ascending ducts drain into the external iliac lymph nodes, the lateral ducts into the hypogastric node chain, and the posterior ducts draining from the caudal prostate to the subaortic lymph nodes of the sacral promontory. 5,6 Weingartner et al. 7 performed extensive PLND on cadavers. A mean lymph node (LN) yield of 20 was found and the authors suggested that this number serve as a guideline for sufficient PLDN. Interestingly, they analyzed prostate cancer patients's LNs and found that they were relatively enlarged, whether they contained cancer or not, compared to non-cancer cadavers.Three approaches to the PLND have been described: limited, standard and extended. 8,9 (Table 1, Figure 1) The exact nomenclature and surgical boundaries of PLND vary between institutions and lack standardization. International consensus on anatomic boundaries and use of descriptive terminology is needed. 9 Standardization would promote uniformity of practice and improve the comparison of future studies on PLND in prostate cancer.What is the optimal anatomic extend of PLND?Considerable debate exists over the appropriate boundaries of PLND during radical retropubic prostatectomy (RRP). Proponents of the extended PLND argue that it significantly increases yield of ...

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