Pelvic Lymph Node Dissection (Extended Vs Standard) And Prostate Cancer

February 14, 2009 at 8:00 am Leave a comment


UroToday.com – The purpose of this article was to review the recent medical papers about the role and potential benefits of extended lymphadenectomy in prostate cancer.



We analyzed clinical prognostic factors on lymphatic disease, imaging techniques used in clinical staging, and reasons for performing an ileo-obturator lymphadenectomy versus an extended lymphadenectomy.



The therapeutic role of the lymphadenectomy in prostate cancer is controversial. However, it is generally accepted that the role of the lymphadenectomy at the time of surgery is the best method of diagnosing lymphatic involvement. Clinical and imaging staging cannot detect lymphatic disease in many instances.



Nevertheless, a number of patients with prostate cancer do not need a pelvic lymphadenectomy. Clinical staging methods allow the selection of patients for lymphadenectomy. The question is, do patients with unfavorable prognostic factors for lymphatic disease require extended lymphadenectomy? Recent reports show that lymphatic prostate drainage occurs at three lymphatic levels and not exclusively at the ileo-obturator level. This scenario justifies an extended lymphadenectomy.



Although an extended lymphadenectomy may accurately pinpoint the lymphatic staging with a low morbidity, there are no papers demonstrating that extended lymphadenectomy improves biochemical progression-free survival.



Written by A. Rincón Mayans, MD as part of Beyond the Abstract on UroToday.com



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