The role of lymphadenectomy in high risk prostate cancer

Abstract

Historically, patients with high risk prostate cancer were considered poor candidates for radical prostatectomy (RP) due to the likelihood of positive pelvic lymph nodes and decreased long term survival. Although there is still no consensus on the optimal therapy for this group of patients, there is increasing evidence that surgery could play a role. Cancer specific survival (CSS) rates after RP for locally advanced disease at 10 year follow up range from 29 to 72%, depending on tumor differentiation. The role of pelvic lymph node dissection (PLND) in prostate cancer remains a controversial topic. Nonetheless, in conjunction with RRP extended PLND (ePLND) should be performed as extended lymph node dissection in lieu of standard PLND may increase staging accuracy, influence decision making with respect to adjuvant therapy and possibly impact outcome. High risk patients with organ confined prostate cancer and low volume (micro)metastatic disease may be the ones to profit most from this approach.

Feasibility of antegrade radical prostatectomy for clinically locally advanced prostate cancer: a comparative study with clinically localized disease

“…Burkhard et al also recommended the same method. 17 Although the incidence of postoperative pelvic hematoma in the current study was higher than those reported by other investigators, 14,16 re-drainage was required in only three of the 32 patients.…”

Phase II trial of short-term neoadjuvant docetaxel and complete androgen blockade in high-risk prostate cancer

“…In our series, only one patient had pathological lymph node involvement. This rate (3.9%) of lymph node disease was considerably lower than what is expected (close to 20%) in extended lymph node dissection in high-risk patients (Heidenreich et al, 2007;Burkhard and Studer, 2008). There are several potential explanations for this discrepancy, including lymph node sampling error or inclusion of not truly high-risk patients.…”

Extended Pelvic Lymph Node Dissection Including Internal Iliac Packet Should Be Performed During Robot-Assisted Laparoscopic Radical Prostatectomy for High-Risk Prostate Cancer

“…[1][2][3] However, previous reports showed long-term survival of patients with positive lymph nodes after radical prostatectomy. 4,5 Furthermore, meticulous dissection of lymph nodes located in the draining region of the primary tumor-bearing organ is a gold standard procedure for most malignant tumors.…”