Utility of Lymphadenectomy in Prostate Cancer: Where Do We Stand?

Małkiewicz, Bartosz; Kiełb, Paweł; Karwacki, Jakub; Czerwińska, Róża; Długosz, Paulina; Lemiński, Artur; Nowak, Łukasz; Krajewski, Wojciech; Szydełko, Tomasz

doi:10.3390/jcm11092343

Cited by 5 publications

(5 citation statements)

References 98 publications

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“…Some studies indicate that lymph node dissection has a limited impact on direct treatment outcomes. 39 , 40 Furthermore, there is a correlation between the degree of lymph node dissection and adverse outcomes during the surgery and the immediate postoperative period. There is a positive correlation between a more comprehensive dissection and several factors, including longer surgical durations, increased blood loss, extended hospital stays, and a heightened risk of postoperative complications.…”

Section: Resultsmentioning

confidence: 99%

Current Controversy and Developments Regarding the Cytoreductive Prostatectomy for Oligometastatic Prostate Cancer

Tian,

Mao,

Tang

et al. 2023

Technol Cancer Res Treat

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Oligometastatic prostate cancer is a term that is most often used to refer to limited sites of disseminated tumor growth following primary radical prostatectomy (RP) or radiotherapy (RT), while de novo oligometastatic is a term that is used to refer to prostate tumors that have disseminated to limited sites before definitive treatment. In patients with de novo oligometastatic prostate cancer, treatment planning must thus consider the need to manage the primary tumor and the associated distant lesions. Traditionally, resectioning primary metastatic tumors is not thought to offer significant benefits to affected patients while increasing their risk of surgery-related complications. Recent clinical evidence indicates that patients undergoing cytoreductive prostatectomy (CRP) may observe substantial enhancements in overall survival rates while not experiencing a noticeable decline in their quality of life. Nevertheless, based on the current body of evidence, it is deemed inadequate to justify revising clinical guidelines. Consequently, it is not advisable to propose CRP for patients with oligometastatic prostate cancer. The present review was compiled to summarize available data regarding the indications, functional outcomes, and oncological outcomes associated with cytoreductive radical prostatectomy to provide a robust and objective foundation that can be used to better assess the value of this interventional strategy from a clinical perspective.

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Section: Resultsmentioning

confidence: 99%

Current Controversy and Developments Regarding the Cytoreductive Prostatectomy for Oligometastatic Prostate Cancer

Tian,

Mao,

Tang

et al. 2023

Technol Cancer Res Treat

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show abstract

“…Accurate detection of metastatic lymph nodes enables clinicians to make informed decisions regarding appropriate treatment approaches, such as extended LND or targeted radiation therapy [51]. Traditional imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) have limitations in detecting small or micrometastatic lymph nodes [52].…”

Section: Discussionmentioning

confidence: 99%

Preoperative Factors for Lymphovascular Invasion in Prostate Cancer: A Systematic Review and Meta-Analysis

Karwacki,

Stodolak,

Nowak

et al. 2024

IJMS

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Lymphovascular invasion (LVI) is one of the most important prognostic factors in prostate cancer (PCa) and is correlated with worse survival rates, biochemical recurrence (BCR), and lymph node metastasis (LNM). The ability to predict LVI preoperatively in PCa may be useful for proposing variations in the diagnosis and management strategies. We performed a systematic review and meta-analysis to identify preoperative clinicopathological factors that correlate with LVI in final histopathological specimens in PCa patients. Systematic literature searches of PubMed, Embase, and Web of Science were performed up to 31 January 2023. A total of thirty-nine studies including 389,918 patients were included, most of which were retrospective and single-center. PSA level, clinical T stage, and biopsy Gleason score were significantly correlated with LVI in PCa specimens. Meta-analyses revealed that these factors were the strongest predictors of LVI in PCa patients. Prostate volume, BMI, and age were not significant predictors of LVI. A multitude of preoperative factors correlate with LVI in final histopathology. Meta-analyses confirmed correlation of LVI in final histopathology with higher preoperative PSA, clinical T stage, and biopsy Gleason score. This study implies advancements in risk stratification and enhanced clinical decision-making, and it underscores the importance of future research dedicated to validation and exploration of contemporary risk factors in PCa.

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“…The ongoing debate in the PCa field regarding ipsi- and contralateral LNI, coupled with emerging studies on sentinel LN mapping, particularly heightens the relevance of our investigation [ 15 , 16 , 35 , 36 , 37 ]. Bilateral pelvic lymphadenectomy performed during RP remains the gold standard for nodal staging [ 38 ]. Despite its debatable therapeutic utility and an increased risk of procedure-associated morbidity, its position in the current guidelines is well-established [ 38 , 39 , 40 , 41 , 42 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

“…Bilateral pelvic lymphadenectomy performed during RP remains the gold standard for nodal staging [ 38 ]. Despite its debatable therapeutic utility and an increased risk of procedure-associated morbidity, its position in the current guidelines is well-established [ 38 , 39 , 40 , 41 , 42 , 43 ]. Nonetheless, a growing perspective suggests that a subset of patients may benefit from unilateral PLND.…”

Section: Discussionmentioning

confidence: 99%

Association of Lymphovascular Invasion with Lymph Node Metastases in Prostate Cancer—Lateralization Concept

Karwacki,

Gurwin,

Jaworski

et al. 2024

Cancers

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Background. Lymphovascular invasion (LVI) is a vital but often overlooked prognostic factor in prostate cancer. As debates on lymphadenectomy’s overtreatment emerge, understanding LVI laterality gains importance. This study pioneers the investigation into PCa, aiming to uncover patterns that could influence tailored surgical strategies in the future. Methods. Data from 96 patients with both LVI and lymph node invasion (LNI) were retrospectively analyzed. All participants underwent radical prostatectomy (RP) with modified-extended pelvic lymph node dissection (mePLND). All specimens underwent histopathological examination. The assessment of LVI was conducted separately for the right and left lobes of the prostate. Associations within subgroups were assessed using U-Mann–Whitney and Kruskal–Wallis tests, as well as Kendall’s tau-b coefficient, yielding p-values and odds ratios (ORs). Results. Out of the 96 patients, 61 (63.5%) exhibited exclusive left-sided lymphovascular invasion (LVI), 24 (25.0%) had exclusive right-sided LVI, and 11 (11.5%) showed bilateral LVI. Regarding nodal involvement, 23 patients (24.0%) had LNI solely on the left, 25 (26.0%) exclusively on the right, and 48 (50.0%) on both sides. A significant correlation was observed between lateralized LVI and lateralized LNI (p < 0.001), particularly in patients with right-sided LVI only. LN-positive patients with left-sided LVI tended to have higher pT stages (p = 0.047) and increased odds ratios (OR) of bilateral LNI (OR = 2.795; 95% confidence interval [CI]: 1.231–6.348) compared to those with exclusive right-sided LVI (OR = 0.692; 95% CI: 0.525–0.913). Conclusions. Unilateral LVI correlates with ipsilateral LNI in PCa patients with positive LNs, notably in cases of exclusively right-sided LVI. Left-sided LVI associates with higher pT stages and a higher percentage of bilateral LNI cases.

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Utility of Lymphadenectomy in Prostate Cancer: Where Do We Stand?

Cited by 5 publications

References 98 publications

Current Controversy and Developments Regarding the Cytoreductive Prostatectomy for Oligometastatic Prostate Cancer

Current Controversy and Developments Regarding the Cytoreductive Prostatectomy for Oligometastatic Prostate Cancer

Preoperative Factors for Lymphovascular Invasion in Prostate Cancer: A Systematic Review and Meta-Analysis

Association of Lymphovascular Invasion with Lymph Node Metastases in Prostate Cancer—Lateralization Concept

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