The Prevalence of Lower Limb and Genital Lymphedema after Prostate Cancer Treatment: A Systematic Review

Abstract

(1) Background: Secondary lymphedema is a chronic, progressive, and debilitating condition with an important impact on quality of life. Lymphedema is a frequently reported complication in oncological surgery but has not been systematically studied in the setting of prostate cancer. (2) Methods: Pubmed/MEDLINE and Embase were systematically searched to identify articles reporting on lower limb or genital lymphedema after primary treatment (surgery of radiation therapy) of the prostate and the pelvic lymph nodes in men with prostate cancer. Primary outcome was the prevalence of lower limb and genital lymphedema. (3) Results: Eighteen articles were eligible for qualitative synthesis. Risk of bias was high in all included studies, with only one study providing a prespecified definition of secondary lymphedema. Eleven studies report the prevalence of lower limb (0–14%) and genital (0–1%) lymphedema after radical prostatectomy with pelvic lymph node dissection (PLND) Seven studies report a low prevalence of lower limb (0–9%) and genital (0–8%) lymphedema after irradiation of the pelvic lymph nodes. However, in the patient subgroups that underwent pelvic irradiation after staging pelvic lymph node dissections, the prevalence of lower limb (18–29%) and genital (2–22%) lymphedema is substantially elevated. (4) Conclusion: Prostate cancer patients undergoing surgery or irradiation of the pelvic lymph nodes are at risk of developing secondary lymphedema in the lower limbs and the genital region. Patients receiving pelvic radiation after pelvic lymph node dissection have the highest prevalence of lymphedema. The lack of a uniform definition and standardized diagnostic criteria for lower limb and genital lymphedema hampers the accurate estimation of their true prevalence. Future clinicals trials are needed to specifically evaluate secondary lymphedema in patients undergoing prostate cancer treatments, to identify potential risk factors and to determine the impact on quality of life.

Preferences for Tailored Support – Patients’ and Health Care Professionals’ Experiences Regarding Symptoms and Self-Management Strategies During the First Year After Curatively Intended Prostate Cancer Treatment

“…[16][17][18][19][20] The patient's experience of lymphoedema was not mentioned in the interviews with HCP and may be explained by that lymphoedema is a condition that is probably underestimated in this group of patients. 32 Furthermore, unlike in the interviews with HCP, patients described that the bodily changes and the new appearance were sources of distress and affected their perceptions of masculinity, a phenomenon which has also been described previously. 33 Both patients and HCP saw masculine norms in society as an obstacle when it came to talking about symptoms, and the diagnosis itself was embarrassing and stigmatizing.…”

Depressive symptoms and their severity in a sample with lymphedema: a case–control investigation

“…It should be noted that our sample is mostly female and that this is justified by the fact that lymphedema of the lower limbs apparently affects more women, with an extensive association of this pathology with gynecological cancer ( 46–48 ). In men, the literature is scarcer, although there is already evidence of a relationship between prostate cancer and lymphedema ( 49 ). In our sample, 25% of the individuals had lymphedema of the lower limbs secondary to cancer or its treatment.…”

The N-LVA Study: effectiveness and cost-effectiveness of lymphaticovenous anastomosis (LVA) for patients with cancer who suffer from chronic peripheral lymphoedema – study protocol of a multicentre, randomised sham-controlled trial

“…The overall incidence of CRL is 15.5%, ranging from 10% in genitourinary cancers to 30% in sarcomas, with the highest rates observed in patients receiving additional radiotherapy (31%) 9. Other factors that contribute to the risk of developing CRL include lymph node dissection, obesity, pre-existing medical conditions and genetic predisposition 11–18. Moreover, the risk of developing lower limb CRL also varies depending on the type of lymph node dissection performed.…”