Urologie pro praxi 3/2021

The role of pelvic lymphadenectomy in the treatment of prostate cancer

Pelvic lymph node dissection (PLND) represents an integral part of staging in prostate cancer (PCa). Guidelines recommend PLND in intermediate and high-risk PCa. The use of PLND has increased recently due to stage migration towards more aggressive PCa. The oncological significance of PLND remains unclear. Some patients after radical prostatectomy (RP) with PLND, remain in oncological remission for a long time, but most of those patients with positive nodes (pN1) require additional adjuvant or salvage treatment. The benefit of PLND must be balanced against the risk of perioperative morbidity. Complications include conditions such as symptomatic lymphocele, deep vein thrombosis (DVT), pulmonary embolism, obturator nerve injury, and large vessel injury. The aim of this article is to describe the current view of the guidelines on PLND, recommendations regarding the extent of PLND, what complications occur when performing PLND, which nomograms can be used to calculate the risk of nodal involvement and what is the role of sentinel node biopsy and salvage lymph node dissection.

Keywords: prostate cancer, radical prostatectomy, pelvic lymph node dissection, salvage lymph node dissection.