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< Vol. 84 Issue 1 | Jan-Mar 2017 | pp. 1 - 64

Pelvic lymph node dissection in prostate cancer: indications, extent and tailored approaches

Pelvic lymph node dissection in prostate cancer: indications, extent and tailored approaches

Urologia 2017; 84(1): 9 - 19

Article Type: REVIEW

DOI:10.5301/uro.5000139

Authors

Lorenzo Bianchi, Giorgio Gandaglia, Nicola Fossati, Nazareno Suardi, Marco Moschini, Vito Cucchiara, Marco Bianchi, Rocco Damiano, Riccardo Schiavina, Shahrokh F. Shariat, Francesco Montorsi, Alberto Briganti

Abstract

Purpose

The purpose of this study is to review the current literature concerning the indication of pelvic lymph node dissection (PLND), its extent and complications in prostate cancer (PCa) staging, the available tools, and the future perspectives to assess the risk of lymph node invasion (LNI).

 Methods

A literature review was performed using the Medline, Embase, and Web of Science databases. The search strategy included the terms pelvic lymph nodes, PLND, radical prostatectomy, prostate cancer, lymph node invasion, biochemical recurrence, staging, sentinel lymph node dissection, imaging, and molecular markers.

 Results

PLND currently represents the gold standard for nodal staging in PCa patients. Available imaging techniques are characterized by poor accuracy in the prediction of LNI before surgery. On the contrary, an extended PLND (ePLND) would result into proper staging in the majority of the cases. Several models based on preoperative disease characteristics are available to assess the risk of LNI. Although ePLND is not associated with a substantial risk of severe complications, up to 10% of the men undergoing this procedure experience lymphoceles. Concerns over potential morbidity of ePLND led many authors to investigate the role of sentinel lymph node dissection in order to prevent unnecessary ePLND. Finally, the incorporation of novel biomarkers in currently available tools would improve our ability to identify men who should receive an ePLND.

 Conclusions

Nowadays, the most informative tools predicting LNI in PCa patients consist in preoperative clinical nomograms. Sentinel lymph node dissection still remains experimental and novel biomarkers are needed to identify patients at a higher risk of LNI.

Article History

  • • Accepted on 21/07/2015
  • • Available online on 16/12/2015
  • • Published in print on 03/02/2017

Disclosures

Financial support: The authors have no financial disclosures to make.
Conflict of interest: The authors have no conflict of interest.

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Authors

Affiliations

  • Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan - Italy
  • Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna - Italy
  • Urology Unit, Magna Graecia University of Catanzaro, Catanzaro - Italy
  • Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna - Austria
  • Lorenzo Bianchi and Giorgio Gandaglia contributed equally to this work

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