Urol. praxi. 2021;22(3):133-138 | DOI: 10.36290/uro.2021.015

The role of pelvic lymphadenectomy in the treatment of prostate cancer

MUDr. Vladimír Študent, Ph.D., FEBU, ml.1, doc. MUDr. Zbyněk Tüdös, Ph.D.2, MUDr. Zuzana Seifriedová1, MUDr. Hana Študentová, Ph.D.3, Mgr. Dana Purová1, prof. MUDr. Vladimír Študent, Ph.D.1
1 Urologická klinika FN Olomouc a LF UP Olomouc
2 Radiologická klinika FN Olomouc a LF UP Olomouc
3 Onkologická klinika FN Olomouc a LF UP Olomouc

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.

Accepted: March 25, 2021; Prepublished online: March 25, 2021; Published: October 21, 2021  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Študent V, Tüdös Z, Seifriedová Z, Študentová H, Purová D, Študent V. The role of pelvic lymphadenectomy in the treatment of prostate cancer. Urol. praxi. 2021;22(3):133-138. doi: 10.36290/uro.2021.015.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Fossati N, Willemse P-PM, Van den Broeck T, et al. The Benefits and Harms of Different Extents of Lymph Node Dissection During Radical Prostatectomy for Prostate Cancer: A Systematic Review. Eur Urol 2017; 72(1): 84-109. doi: 10.1016/j.eururo.2016.12.003. Go to original source... Go to PubMed...
    2. Bishoff JT, Reyes A, Thompson IM, et al. Pelvic lymphadenectomy can be omitted in selected patients with carcinoma of the prostate: development of a system of patient selection. Urology 1995; 45(2): 270-274. doi: 10.1016/0090-4295(95)80017-4. Go to original source... Go to PubMed...
    3. Gandaglia G, Ploussard G, Valerio M, et al. A Novel Nomogram to Identify Candidates for Extended Pelvic Lymph Node Dissection Among Patients with Clinically Localized Prostate Cancer Diagnosed with Magnetic Resonance Imaging-targeted and Systematic Biopsies. Eur Urol 2019; 75(3): 506-514. doi: 10.1016/j.eururo.2018.10.012. Go to original source... Go to PubMed...
    4. Wilkins LJ, Tosoian JJ, Sundi D, et al. Surgical management of high-risk, localized prostate cancer. Nat Rev Urol 2020; 17(12): 679-690. doi: 10.1038/s41585-020-00384-7. Go to original source... Go to PubMed...
    5. van den Bergh R, Gandaglia G, Tilki D, et al. Trends in Radical Prostatectomy Risk Group Distribution in a European Multicenter Analysis of 28 572 Patients: Towards Tailored Treatment. Eur Urol Focus 2019; 5(2): 171-178. doi: 10.1016/j.euf.2017.07.003. Go to original source... Go to PubMed...
    6. Študent V, ml Študent V. Trendy ve využívání pánevní lymfadenektomie při roboticky asistované radikální prostatektomii. Ces Urol 2020; 24(Suppl.A): 28.
    7. Ploussard G, Briganti A, de la Taille A, et al. Pelvic Lymph Node Dissection During Robot-assisted Radical Prostatectomy: Efficacy, Limitations, and Complications - a Systematic Review of the Literature. Eur Urol. 2014; 65(1): 7-16. doi: 10.1016/j.eururo.2013.03.057. Go to original source... Go to PubMed...
    8. Heidenreich A, Ohlmann CH, Polyakov S. Anatomical Extent of Pelvic Lymphadenectomy in Patients Undergoing Radical Prostatectomy. Eur Urol. 2007; 52(1): 29-37. doi: 10.1016/j.eururo.2007.04.020. Go to original source... Go to PubMed...
    9. Weingartner K, Ramaswamy A, Bittinger A, Gerharz EW, Voge D, Riedmiller H. Anatomical Basis for Pelvic Lymphadenectomy in Prostate Cancer: Results of an Autopsy Study and Implications for the Clinic. J Urol. 1996; 156(6): 1969-1971. doi: 10.1016/S0022-5347(01)65406-5. Go to original source... Go to PubMed...
    10. Mattei A, Fuechsel FG, Bhatta Dhar N, et al. The Template of the Primary Lymphatic Landing Sites of the Prostate Should Be Revisited: Results of a Multimodality Mapping Study. Eur Urol. 2008; 53(1): 118-125. doi: 10.1016/j.eururo.2007.07.035. Go to original source... Go to PubMed...
    11. Joniau S, Van den Bergh L, Lerut E, et al. Mapping of Pelvic Lymph Node Metastases in Prostate Cancer. Eur Urol. 2013; 63(3): 450-458. doi: 10.1016/j.eururo.2012.06.057. Go to original source... Go to PubMed...
    12. Weckermann D, Dorn R, Trefz M, Wagner T, Wawroschek F, Harzmann R. Sentinel Lymph Node Dissection for Prostate Cancer: Experience With More Than 1,000 Patients. J Urol. 2007; 177(3): 916-920. doi: 10.1016/j.juro.2006.10.074. Go to original source... Go to PubMed...
    13. Heidenreich A, Varga Z, Von Knobloch R. Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis. J Urol. 2002; 167(4): 1681-1686. http://www.ncbi.nlm.nih.gov/pubmed/11912387. Go to original source... Go to PubMed...
    14. Mottet N, Cornford P, van den Bergh RCN, Briers E, De Santis M. EAU-ESTRO-ESUR-SIOG Guidelines on prostate cancer. https://uroweb.org/guideline/prostate-cancer/. Accessed March 13, 2021.
    15. Briganti A, Larcher A, Abdollah F, et al. Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: The essential importance of percentage of positive cores. Eur Urol. 2012; 61(3): 480-487. doi: 10.1016/j.eururo.2011.10.044. Go to original source... Go to PubMed...
    16. Sanda MG, Cadeddu JA, Kirkby E, et al. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. Part I: Risk Stratification, Shared Decision Making, and Care Options. J Urol. 2018; 199(3): 683-690. doi:10.1016/j.juro.2017.11.095. Go to original source... Go to PubMed...
    17. Mohler JL, Antonarakis ES, Armstrong AJ, et al. Prostate Cancer, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw. 2019; 17(5): 479-505. doi: 10.6004/jnccn.2019.0023. Go to original source... Go to PubMed...
    18. Nocera L, Sood A, Dalela D, et al. Rate and Extent of Pelvic Lymph Node Dissection in the US Prostate Cancer Patients Treated With Radical Prostatectomy. Clin Genitourin Cancer. 2018; 16(2): e451-e467. doi: 10.1016/j.clgc.2017.10.003. Go to original source... Go to PubMed...
    19. Partin AW, Yoo J, Carter HB, et al. The Use of Prostate Specific Antigen, Clinical Stage and Gleason Score to Predict Pathological Stage in Men with Localized Prostate Cancer. J Urol. 1993; 150(1): 110-114. doi: 10.1016/S0022-5347(17)35410-1. Go to original source... Go to PubMed...
    20. Partin AW, Mangold LA, Lamm DM, Walsh PC, Epstein JI, Pearson JD. Contemporary update of prostate cancer staging nomograms (Partin Tables) for the new millennium. Urology. 2001; 58(6): 843-848. doi: 10.1016/S0090-4295(01)01441-8. Go to original source... Go to PubMed...
    21. Eifler JB, Feng Z, Lin BM, et al. An updated prostate cancer staging nomogram (Partin tables) based on cases from 2006 to 2011. BJU Int. 2013; 111(1): 22-29. doi: 10.1111/j.1464-410X.2012.11324.x. Go to original source... Go to PubMed...
    22. Hansen J, Rink M, Bianchi M, et al. External validation of the updated briganti nomogram to predict lymph node invasion in prostate cancer patients undergoing extended lymph node dissection. Prostate 2013; 73(2): 211-218. doi: 10.1002/pros.22559. Go to original source... Go to PubMed...
    23. Memorial Sloan Kettering Cancer Centre. Dynamic Prostate Cancer Nomogram. https://www.mskcc.org/nomograms/prostate/pre_op. Accessed March 13, 2021.
    24. Soeterik TFW, Hueting TA, Israel B, et al. External validation of the MSKCC and Briganti Nomograms For Prediction of Lymph Node Involvement of Prostate Cancer Using Clinical Stage assessed by Magnetic Resonance Imaging. BJU Int. February 2021: bju.15376. doi: 10.1111/bju.15376. Go to original source... Go to PubMed...
    25. Gandaglia G, Fossati N, Zaffuto E, et al. Development and Internal Validation of a Novel Model to Identify the Candidates for Extended Pelvic Lymph Node Dissection in Prostate Cancer. Eur Urol. 2017; 72(4): 632-640. doi: 10.1016/j.eururo.2017.03.049. Go to original source... Go to PubMed...
    26. Gandaglia G, Martini A, Ploussard G, et al. External Validation of the 2019 Briganti Nomogram for the Identification of Prostate Cancer Patients Who Should Be Considered for an Extended Pelvic Lymph Node Dissection. Eur Urol. 2020; 78(2): 138-142. doi: 10.1016/j.eururo.2020.03.023. Go to original source... Go to PubMed...
    27. Motterle G, Ahmed ME, Andrews JR, Karnes RJ. The Role of Radical Prostatectomy and Lymph Node Dissection in Clinically Node Positive Patients. Front Oncol. 2019; 9. doi: 10.3389/fonc.2019.01395. Go to original source... Go to PubMed...
    28. Jansen BHE, Nieuwenhuijzen JA, Oprea-Lager DE, et al. Adding multiparametric MRI to the MSKCC and Partin nomograms for primary prostate cancer: Improving local tumor staging? Urol Oncol Semin Orig Investig. 2019; 37(3): 181.e1-181.e6. doi: 10.1016/j.urolonc.2018.10.026. Go to original source... Go to PubMed...
    29. Schiavina R, Scattoni V, Castellucci P, et al. 11C-Choline Positron Emission Tomography/Computerized Tomography for Preoperative Lymph-Node Staging in Intermediate-Risk and High-Risk Prostate Cancer: Comparison with Clinical Staging Nomograms. Eur Urol. 2008; 54(2): 392-401. doi: 10.1016/j.eururo.2008.04.030. Go to original source... Go to PubMed...
    30. van Leeuwen PJ, Emmett L, Ho B, et al. Prospective evaluation of 68Gallium-prostate-specific membrane antigen positron emission tomography/computed tomography for preoperative lymph node staging in prostate cancer. BJU Int. 2017; 119(2): 209-215. doi: 10.1111/bju.13540. Go to original source... Go to PubMed...
    31. van Leeuwen PJ, Donswijk M, Nandurkar R, et al. Gallium-68-prostate-specific membrane antigen (68Ga-PSMA) positron emission tomography (PET)/computed tomography (CT) predicts complete biochemical response from radical prostatectomy and lymph node dissection in intermediate - and high-risk prostate cance. BJU Int. 2019; 124(1): 62-68. doi: 10.1111/bju.14506. Go to original source... Go to PubMed...
    32. Kolthammer JA, Su K-H, Grover A, Narayanan M, Jordan DW, Muzic RF. Performance evaluation of the Ingenuity TF PET/CT scanner with a focus on high count-rate conditions. Phys Med Biol. 2014; 59(14): 3843-3859. doi: 10.1088/0031-9155/59/14/3843. Go to original source... Go to PubMed...
    33. Harisinghani MG, Barentsz J, Hahn PF, et al. Noninvasive Detection of Clinically Occult Lymph-Node Metastases in Prostate Cancer. N Engl J Med. 2003; 348(25): 2491-2499. doi: 10.1056/NEJMoa022749. Go to original source... Go to PubMed...
    34. Zarzour JG, Galgano S, McConathy J, Thomas J V, Rais-Bahrami S. Lymph node imaging in initial staging of prostate cancer: An overview and update. World J Radiol. 2017; 9(10): 389-399. doi: 10.4329/wjr.v9.i10.389. Go to original source... Go to PubMed...
    35. Hofman MS, Lawrentschuk N, Francis RJ, et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet. 2020; 395(10231): 1208-1216. doi: 10.1016/S0140-6736(20)30314-7. Go to original source... Go to PubMed...
    36. Cheung DC, Fleshner N, Sengupta S, Woon D. A narrative review of pelvic lymph node dissection in prostate cancer. Transl Androl Urol. 2020; 9(6): 3049-3055. doi: 10.21037/tau-20-729. Go to original source... Go to PubMed...
    37. Hinsenveld FJ, Wit EMK, van Leeuwen PJ, et al. Prostate-Specific Membrane Antigen PET/CT Combined with Sentinel Node Biopsy for Primary Lymph Node Staging in Prostate Cancer. J Nucl Med. 2020; 61(4): 540-545. doi: 10.2967/jnumed.119.232199. Go to original source... Go to PubMed...
    38. Roach PJ, Francis R, Emmett L, et al. The Impact of 68 Ga-PSMA PET/CT on Management Intent in Prostate Cancer: Results of an Australian Prospective Multicenter Study. J Nucl Med. 2018; 59(1): 82-88. doi: 10.2967/jnumed.117.197160. Go to original source... Go to PubMed...
    39. van der Poel HG, Wit EM, Acar C, et al. Sentinel node biopsy for prostate cancer: report from a consensus panel meeting. BJU Int. 2017; 120(2): 204-211. doi: 10.1111/bju.13810. Go to original source... Go to PubMed...
    40. Wit EMK, Acar C, Grivas N, et al. Sentinel Node Procedure in Prostate Cancer: A Systematic Review to Assess Diagnostic Accuracy. Eur Urol. 2017; 71(4): 596-605. doi: 10.1016/j.eururo.2016.09.007. Go to original source... Go to PubMed...
    41. Harke NN, Godes M, Wagner C, et al. Fluorescence-supported lymphography and extended pelvic lymph node dissection in robot-assisted radical prostatectomy: a prospective, randomized trial. World J Urol. 2018; 36(11): 1817-1823. doi: 10.1007/s00345-018-2330-7. Go to original source... Go to PubMed...
    42. Lestingi JFP, Guglielmetti G, Pontes Jr J, et al. Extended versus limited pelvic lymphadenectomy during radical prostatectomy for intermediate - and high-risk prostate cancer: Early outcomes from a randomized controlled phase III study. J Clin Oncol. 2017; 35(15_suppl): 5018-5018. doi: 10.1200/JCO.2017.35.15_suppl.5018. Go to original source...
    43. Chen J, Wang Z, Zhao J, et al. Pelvic lymph node dissection and its extent on survival benefit in prostate cancer patients with a risk of lymph node invasion >5%: a propensity score matching analysis from SEER database. Sci Rep. 2019; 9(1): 17985. doi: 10.1038/s41598-019-54261-4. Go to original source... Go to PubMed...
    44. Preisser F, van den Bergh RCN, Gandaglia G, et al. Effect of Extended Pelvic Lymph Node Dissection on Oncologic Outcomes in Patients with D'Amico Intermediate and High Risk Prostate Cancer Treated with Radical Prostatectomy: A Multi-Institutional Study. J Urol. 2020; 203(2): 338-343. doi: 10.1097/JU.0000000000000504. Go to original source... Go to PubMed...
    45. Lestingi JFP, Guglielmetti GB, Trinh Q-D, et al. Extended Versus Limited Pelvic Lymph Node Dissection During Radical Prostatectomy for Intermediate - and High-risk Prostate Cancer: Early Oncological Outcomes from a Randomized Phase 3 Trial. Eur Urol. December 2020. doi: 10.1016/j.eururo.2020.11.040. Go to original source... Go to PubMed...
    46. Joslyn SA, Konety BR. Impact of extent of lymphadenectomy on survival after radical prostatectomy for prostate cancer. Urology 2006; 68(1): 121-125. doi: 10.1016/j.urology.2006.01.055. Go to original source... Go to PubMed...
    47. Marra G, Valerio M, Heidegger I, et al. Management of Patients with Node-positive Prostate Cancer at Radical Prostatectomy and Pelvic Lymph Node Dissection: A Systematic Review. Eur Urol Oncol. 2020; 3(5): 565-581. doi: 10.1016/j.euo.2020.08.005. Go to original source... Go to PubMed...
    48. Briganti A, Chun FK-H, Salonia A, et al. Complications and Other Surgical Outcomes Associated with Extended Pelvic Lymphadenectomy in Men with Localized Prostate Cancer. Eur Urol. 2006; 50(5): 1006-1013. doi: 10.1016/j.eururo.2006.08.015. Go to original source... Go to PubMed...
    49. Deutsch S, Hadaschik B, Lebentrau S, Ubrig B, Burger M, May M. Clinical Importance of a Peritoneal Interposition Flap to Prevent Symptomatic Lymphoceles after Robot-Assisted Radical Prostatectomy and Pelvic Lymph Node Dissection: A Systematic Review and Meta-Analysis. Urol Int. February 2021: 1-7. doi: 10.1159/000512960. Go to original source... Go to PubMed...
    50. Motterle G, Morlacco A, Zanovello N, et al. Surgical Strategies for Lymphocele Prevention in Minimally Invasive Radical Prostatectomy and Lymph Node Dissection: A Systematic Review. J Endourol. 2020; 34(2): 113-120. doi: 10.1089/end.2019.0716. Go to original source... Go to PubMed...
    51. Secin FP, Jiborn T, Bjartell AS, et al. Multi-institutional Study of Symptomatic Deep Venous Thrombosis and Pulmonary Embolism in Prostate Cancer Patients Undergoing Laparoscopic or Robot-Assisted Laparoscopic Radical Prostatectomy. Eur Urol. 2008; 53(1): 134-145. doi: 10.1016/j.eururo.2007.05.028. Go to original source... Go to PubMed...
    52. Gözen AS, Aktoz T, Akin Y, Klein J, Rieker P, Rassweiler J. Is It Possible to Draw a Risk Map for Obturator Nerve Injury During Pelvic Lymph Node Dissection? The Heilbronn Experience and a Review of the Literature. J Laparoendosc Adv Surg Tech. 2015; 25(10): 826-832. doi: 10.1089/lap.2015.0190. Go to original source... Go to PubMed...
    53. Musch M, Klevecka V, Roggenbuck U, Kroepfl D. Complications of Pelvic Lymphadenectomy in 1,380 Patients Undergoing Radical Retropubic Prostatectomy Between 1993 and 2006. J Urol. 2008; 179(3): 923-929. doi: 10.1016/j.juro.2007.10.072. Go to original source... Go to PubMed...
    54. Keegan KA, Cookson MS. Complications of Pelvic Lymph Node Dissection for Prostate Cancer. Curr Urol Rep. 2011; 12(3): 203-208. doi: 10.1007/s11934-011-0179-z. Go to original source... Go to PubMed...
    55. Naselli A, Andreatta R, Introini C, Fontana V, Puppo P. Predictors of Symptomatic Lymphocele After Lymph Node Excision and Radical Prostatectomy. Urology 2010; 75(3): 630-635. doi: 10.1016/j.urology.2009.03.011. Go to original source... Go to PubMed...
    56. Eastham JA. Salvage Pelvic Lymph Node Dissection for Nodal Recurrence After Radical Prostatectomy Results in Minimal Clinical Benefit. Eur Urol. 2020; 78(5): 670. doi: 10.1016/j.eururo.2020.07.014. Go to original source... Go to PubMed...
    57. Winter A, Uphoff J, Henke R-P, Wawroschek F. First Results of [11C]choline PET/CT-Guided Secondary Lymph Node Surgery in Patients with PSA Failure and Single Lymph Node Recurrence after Radical Retropubic Prostatectomy. Urol Int. 2010; 84(4): 418-423. doi: 10.1159/000296298. Go to original source... Go to PubMed...
    58. Karnes RJ, Murphy CR, Bergstralh EJ, et al. Salvage Lymph Node Dissection for Prostate Cancer Nodal Recurrence Detected by 11 C-Choline Positron Emission Tomography/Computerized Tomography. J Urol. 2015; 193(1): 111-116. doi: 10.1016/j.juro.2014.08.082. Go to original source... Go to PubMed...
    59. Tilki D, Mandel P, Seeliger F, et al. Salvage Lymph Node Dissection for Nodal Recurrence of Prostate Cancer after Radical Prostatectomy. J Urol. 2015; 193(2): 484-490. doi: 10.1016/j.juro.2014.08.096. Go to original source... Go to PubMed...
    60. Suardi N, Gandaglia G, Gallina A, et al. Long-term Outcomes of Salvage Lymph Node Dissection for Clinically Recurrent Prostate Cancer: Results of a Single-institution Series with a Minimum Follow-up of 5 Years. Eur Urol. 2015; 67(2): 299-309. doi: 10.1016/j.eururo.2014.02.011. Go to original source... Go to PubMed...
    61. Bravi CA, Fossati N, Gandaglia G, et al. Long-term Outcomes of Salvage Lymph Node Dissection for Nodal Recurrence of Prostate Cancer After Radical Prostatectomy: Not as Good as Previously Thought. Eur Urol. 2020; 78(5): 661-669. doi:10.1016/j.eururo.2020.06.043. Go to original source... Go to PubMed...
    62. Rischke HC, Schultze-Seemann W, Wieser G, et al. Adjuvant radiotherapy after salvage lymph node dissection because of nodal relapse of prostate cancer versus salvage lymph node dissection only. Strahlentherapie und Onkol. 2015; 191(4): 310-320. doi: 10.1007/s00066-014-0763-5. Go to original source... Go to PubMed...

    Return to the content


    Urology for Practice

    Madam, Sir,
    please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
    Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

    I declare:

    1. that I have met the above instruction
    2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited

    No
    Yes

    If your statement is not true, please be aware
    that brings the risk of danger to their health or the health of others.