Is it necessary to do staging pelvic lymph node dissection for T1c prostate cancer?

Abstract

The necessity of pelvic lymph node dissection has been questioned in recent years as a result of improved pre-treatment staging based on clinical and pathologic factors. Accurate evaluation of nodal status allows rational selection of therapy and improved outcomes. Nevertheless, lymph node dissection may play a role even in patients with low stage disease (clinical T1c) despite an overall low risk for metastases. Herein we discuss recent advances in the evaluation of lymph nodes in stage T1c prostate cancer with respect to accurate prediction, radiologic imaging, molecular characterization, and operative considerations.

Extending the indications and anatomical limits of pelvic lymph node dissection for prostate cancer: improved staging or increased morbidity?

“…As a result of PSA‐based screening, most prostate cancer cases are diagnosed at an earlier stage and the proportion of men with nodal metastasis at the time of surgery has decreased. Subsequently, the anatomical template and indications of PLND became limited and nodal metastasis had been considered as a rare event in prostate cancer [1–3]. Only in recent years, concurrent with modern series from centres performing the standard or more extended PLND, has an incidence of nodal metastases as high as 24% been revealed.…”

“…The role of lymphadenectomy in prostate cancer has shifted from necessary to optional. This change is partly a result of the downward stage migration seen in prostate cancer with the advent of PSA and the extensive use of personal screening, whereby more patients diagnosed today present with less aggressive tumours of a much smaller volume [1–3]. However, although a high incidence and heavy nodal metastatic burden similar to that reported in the pre PSA era [4,5] is seldom seen, one can anticipate that the incidence of lymph node metastasis in the post PSA era is underestimated.…”

Biological dose volume histograms during conformal hypofractionated accelerated radiotherapy for prostate cancer

“…In high risk prostate carcinomas ͑advanced T-stage or high gleason score͒ lymphatic spread occurs in 25%-45% of cases, [15][16][17] so that pelvic irradiation may contribute to the prevention of regional recurrences.…”