Is a Limited Lymph Node Dissection An Adequate Staging Procedure for Prostate Cancer?

Abstract

There were significant numbers of lymph node metastases at all 3 different areas of lymphadenectomy. Positive lymph nodes were found along the internal iliac artery in more than half (58%) of the patients and exclusively in 19%. Therefore, we consider lymph node dissection along the internal iliac (hypogastric) vessels essential for representative staging. Without this dissection a fifth of node positive cases would have been under staged and diseased nodes would have remained in more than half of the cases.

Prognostic factors in lymph node metastases of prostatic cancer patients: the size of the metastases but not extranodal extension independently predicts survival

“…The lymphadenectomy in prostatic cancer is a staging procedure that may additionally have a favourable impact on survival. 4,23,25,26 Extension of the surgical field of pelvic lymphadenectomy not only substantially enhances staging accuracy in prostatic cancer, 16,25,27 but may also be therapeutically beneficial. 28 We detected a median of 21 lymph nodes per patient in the specimens of extended lymphadenectomy.…”

“…Open bilateral pelvic lymphadenectomy was uniformly performed as previously described. 16 The proximal border of the surgical field was the bifurcation of the common iliac artery. At first, lymph node dissection was performed along the external iliac vein down to the deep circumflex iliac vein and femoral canal.…”

Does quantification of USPIO uptake‐related signal loss allow differentiation of benign and malignant normal‐sized pelvic lymph nodes?

“…The correct staging of lymph node involvement in patients with bladder or prostate cancer is of major prognostic relevance and decisive for treatment planning (1)(2)(3)(4)(5)(6). Until now morphological criteria based on size and shape in CT and MRI have been the mainstay of staging used in clinical routine with a limited diagnostic accuracy and a high number of false-negative results in different imaging studies (7)(8)(9)(10)(11)(12)(13)(14). Although MRI is superior to CT in the detection of small lymph nodes (15), its diagnostic accuracy to differentiate between benign and malignant lymph nodes remains questionable, especially in normal-sized nodes.…”

Impact of Lymph Node Burden on Survival of High-risk Prostate Cancer Patients Following Radical Prostatectomy and Pelvic Lymph Node Dissection

“…Some studies, which also assessed hard endpoints, only analyzed an LN positive cohort, without taking into account pN0 patients with the same primary tumor stage. Such analyses are biased by presuming upfront that patients with one of the more positive LNs have a worse CSS compared to pN0 (11, 18, 19). To avoid this bias, we included all high-risk PCa patients in our analysis, rather than only pN1 PCa patients and offer the possibility to determine the individual prognostic value of all possible individual covariate risk factors.…”

“…We compensated for this by only selecting patients in whom at least 10 and a median of 15 LNs were removed, which can be considered as a reasonable surrogate for PLND. Nevertheless, due to the wide variation in number of nodes in the primary landing sites, the number of examined nodes might not be the best surrogate for the extent of the PLND and boundaries of the dissection template might be at least as important in defining whether all primary landing sites are removed (19, 20). Finally, data were generated over a long period of time with an unknown number of surgeons, various protocols for pathological assessment of the lymphadenectomy specimens, and varying approaches to the initiation and the continuation of adjuvant treatment.…”