Skip to main content
Log in

Role of lymphadenectomy in clinically organ-confined prostate cancer

  • Topic Paper
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

There has been considerable debate about the utility of pelvic lymph node dissection (PLND) when performing a radical prostatectomy. Reported practices vary from those who always perform an extended PLND to those who employ a predictive nomogram in their decision making to those who are increasingly not performing a PLND in low-risk disease. A Medline search was used to identify relevant manuscripts dealing with the role of lymphadenectomy in clinically organ-confined prostate cancer. A greater number of lymph nodes (LN) removed and examined at prostatectomy for prostate cancer appears to increase the likelihood of finding LN metastases and increase prostate cancer-specific survival even in patients who have histologically uninvolved LN. This survival benefit may result from more accurate staging and possible removal of occult metastases. The need for and extent of PLND in prostate cancer, especially in low-risk disease, however, is unlikely.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Danella JF, deKernion JB, Smith RB et al (1993) The contemporary incidence of lymph node metastases in prostate cancer: implications for laparoscopic lymph node dissection. J Urol 149:1488–1491

    PubMed  CAS  Google Scholar 

  2. Petros JA, Catalona WJ (1992) Lower incidence of unsuspected lymph node metastasis in 512 consecutive patients with clinically localized prostate cancer. J Urol 147:1574–1575

    PubMed  CAS  Google Scholar 

  3. Gervasi LA, Mata J, Easley JD et al (1989) Prognostic significance of lymph nodal metastases in prostate cancer. J Urol 142:332–336

    PubMed  CAS  Google Scholar 

  4. Partin AW, Mangold LA, Lamm DM, Walsh PC, Epstein JI, Pearson JD (2001) Contemporary update of prostate cancer staging nomograms (Partin tables) for the new millennium. Urology 58(6):843–848

    Article  PubMed  CAS  Google Scholar 

  5. Narayan P, Fournier G, Gajendran V et al (1994) Utility of preoperative serum prostate specific antigen concentration and biopsy Gleason score in predicting risk of pelvic lymph node metastases in prostate cancer. Urology 44:519–524

    Article  PubMed  CAS  Google Scholar 

  6. Bluestein DL, Bostwick DG, Bergstralh EJ et al (1994) Eliminating the need for bilateral pelvic lymphadenectomy in select patients with prostate cancer. J Urol 151:1315–1320

    PubMed  CAS  Google Scholar 

  7. Partin AW, Kattan MW, Subong EN et al (1997) Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update. JAMA 277:1445–1451

    CAS  Google Scholar 

  8. Cagiannos I, Karakiewicz P, Eastham JA et al (2003) A preoperative nomogram identifying decreased risk of positive pelvic lymph nodes in patients with prostate cancer. J Urol 170(5):1798–1803

    Article  PubMed  Google Scholar 

  9. Augustin H, Eggert T, Wenske S et al (2004) Comparison of accuracy between the Partin tables of 1997 and 2001 to predict final pathological stage in clinically localized prostate cancer. J Urol 171:177–181

    Article  PubMed  Google Scholar 

  10. Wolf JS Jr, Cher M, Dall’era M, Presti JC Jr, Hricak H, Carroll PR (1995) The use and accuracy of cross-sectional imaging and fine needle aspiration cytology for detection of pelvic lymph node metastases before radical prostatectomy. J Urol 153(3 Pt 2):993–999; review

    Google Scholar 

  11. Tempany CM, McNeil BJ (2001) Advances in biomedical imaging. JAMA 285(5):562–567

    Article  PubMed  CAS  Google Scholar 

  12. Cabanas RM (1977) An approach for the treatment of penile carcinoma. Cancer 39:456

    Article  PubMed  CAS  Google Scholar 

  13. Wawroschek F, Vogt H, Weckermann D, Wagner T, Hamm M, Harzmann R (2001) Radioisotope guided pelvic lymph node dissection for prostate cancer. J Urol 166:1715

    Article  PubMed  CAS  Google Scholar 

  14. Weckermann D, Dorn R, Holl G, Wagner T, Harzmann R (2006) Limitations of radioguided surgery in high-risk prostate cancer. Eur Urol 11 Sep 2006 (epub ahead of print)

  15. Borley N, Fabrin K, Sriprasad S et al (2003) Laparoscopic pelvic lymph node dissection allows significantly more accurate staging in “high-risk” prostate cancer compared to MRI or CT. Scand J Urol Nephrol 37:382–386

    Article  PubMed  Google Scholar 

  16. Mattei A et al (2006) Anatomic localization of prostatic sentinel lymph nodes (SLN) according to fusion imaging of SPECT and CT scans after intraprostatic injection of Technetium-99m-Nanocolloid. J Urol 175(S4):448, Abstract 1388

    Google Scholar 

  17. Harisinghani MG, Barentsz J, Hahn PF et al (2003) Noninvasive detection of clinically occult lymph-node metastases in prostate cancer. N Engl J Med 348:2491–2499

    Article  PubMed  Google Scholar 

  18. Troyer JK, Beckett ML, Wright GL Jr (1997) Location of prostate-specific membrane antigen in the LN CaP prostate carcinoma cell line. Prostate 30:232–242

    Article  PubMed  CAS  Google Scholar 

  19. Katz AE, Olsson CA, Raffo AJ et al (1994) Molecular staging of prostate cancer with the use of an enhanced reverse transcriptase-PCR assay. Urology 43:765–775

    Article  PubMed  CAS  Google Scholar 

  20. Briganti A, Chun FK, Salonia A, Gallina A, Farina E, Da Pozzo LF, Rigatti P, Montorsi F, Karakiewicz PI (2006) Validation of a nomogram predicting the probability of lymph node invasion based on the extent of pelvic lymphadenectomy in patients with clinically localized prostate cancer. BJU Int 98(4):788–793

    Article  PubMed  Google Scholar 

  21. Weingartner A, Ramaswamy A, Bittinger A et al (1996) Anatomical basis for pelvic lymphadenectomy in prostate cancer results of an autopsy study and implications for the clinic. J Urol 156:1969–1971

    Article  PubMed  CAS  Google Scholar 

  22. Messing EM, Manola J, Yao J, Kiernan M, Crawford D, Wilding G, di’SantAgnese PA, Trump D; Eastern Cooperative Oncology Group study EST 3886 (2006) Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy. Lancet Oncol 7(6):472–479

    Google Scholar 

  23. Heidenreich A, Varga Z, von Knobloch R (2002) Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis. J Urol 167:1681–1684

    Article  PubMed  Google Scholar 

  24. Bader P, Burkhard FC, Markwalder R, Studer UE (2002) Is a limited lymph node dissection an adequate staging procedure for prostate cancer? J Urol 168:514–518

    Article  PubMed  Google Scholar 

  25. Stone NN, Stock RG, Unger P (1997) Laparoscopic pelvic lymph node dissection for prostate cancer: comparison to the extended and modified techniques. J Urol 158:1891–1894

    Article  PubMed  CAS  Google Scholar 

  26. Clark T, Parekh DJ, Cookson MS et al (2003) Randomized prospective evaluation of extended versus limited lymph node dissection in patients with clinically localized prostate cancer. J Urol 169:145–148

    Article  PubMed  Google Scholar 

  27. Aus G, Abbou CC, Bolla M et al (2005) EAU guidelines on prostate cancer. Eur Urol 48:546–551

    Article  PubMed  CAS  Google Scholar 

  28. Golimbu M, Provet J, Al-Askari S, Morales P (1987) Radical prostatectomy for stage D1 prostate cancer. Prognostic variables and results of treatment. Urology 30:427–435

    Article  PubMed  CAS  Google Scholar 

  29. Catalona WJ, Miller DR, Kavoussi LR (1988) Intermediate-term survival results in clinically understaged prostate cancer patients following radical prostatectomy. J Urol 140:540–543

    PubMed  CAS  Google Scholar 

  30. Pound CR, Partin AW, Eisenberger MA, Chan DW, Pearson JD, Walsh PC (1999) Natural history of progression after PSA elevation following radical prostatectomy. JAMA 281(17):1591–1597

    Article  PubMed  CAS  Google Scholar 

  31. Bader P, Burkhard FC, Markwalder R, Studer UE (2003) Disease progression and survival of patients with positive lymph nodes after radical prostatectomy. Is there a chance of cure? J Urol 169:849–854

    Article  PubMed  Google Scholar 

  32. Daneshmand S, Quek ML, Stein JP, Lieskovsky G, Cai J, Pinski J, Skinner EC, Skinner DG (2004) Prognosis of patients with lymph node positive prostate cancer following radical prostatectomy: long-term results. J Urol 172(6 Pt 1):2252–2255

    Article  PubMed  Google Scholar 

  33. Allaf ME, Palapattu GS, Trock BJ, Carter HB, Walsh PC (2004) Anatomical extent of lymph node dissection: impact on men with clinically localized prostate cancer J Urol 175(85 Pt 1):1840–1844

    Article  Google Scholar 

  34. Bader P, Spahn M, Huber R, Echtle D, Frohneberg D (2004) Limited lymph node dissection in prostate cancer may miss lymph node metastases and determines outcome of apparently pN0 prostate cancer. Eur Urol 3(Suppl):16; abstract no. 55

    Google Scholar 

  35. Joslyn S, Konety B (2006) Impact of extent of lymphadenectomy on survival after radical prostatectomy for prostate cancer. Urology 68(1):121–125

    Article  PubMed  Google Scholar 

  36. Masterson TA, Bianco FJ Jr, Vickers AJ, DiBlasio CJ, Fearn PA, Rabbani F, Eastham JA, Scardino PT (2006) The association between total and positive lymph node counts, and disease progression in clinically localized prostate cancer. J Urol 175(4):1320–1324; discussion 1324–1325

    Google Scholar 

  37. Ferrari AC, Stone NN, Kurek R et al (2006) Molecular load of pathologically occult metastases in pelvic lymph nodes is an independent prognostic marker of biochemical failure after localized prostate cancer treatment. J Clin Oncol 24(19):3081–3088

    Article  PubMed  CAS  Google Scholar 

  38. Serni S, Masieri L, Minervini A, Lapini A, Nesi G, Carini M (2006) Cancer progression after anterograde radical prostatectomy for pathologic Gleason score 8 to 10 and influence of concomitant variables. Urology 67:373–378

    Article  PubMed  Google Scholar 

  39. Feinstein AR, Sosin DM, Wells CK (1985) The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer. N Engl J Med 312:1604–1608

    Article  PubMed  CAS  Google Scholar 

  40. DiMarco DS, Zincke H, Sebo TJ, Slezak J, Bergstralh EJ, Blute ML (2005) The extent of lymphadenectomy for pTXNO prostate cancer does not affect prostate cancer outcome in the prostate specific antigen era. J Urol 173(4):1121–1125

    Article  PubMed  Google Scholar 

  41. Schumacher M, Burkhard F, Thalmann G, Fleischmann A, Studer U. Is pelvic lymph node dissection necessary in patients with a serum PSA<10 ng/ml undergoing radical prostatectomy for prostate cancer? Euro Urol 50(2):272–279

  42. Grossfeld GD, Chang JJ, Broering JM, Li Y, Lubeck DP, Flanders SC et al (2001) Under staging and under grading in a contemporary series of patients undergoing radical prostatectomy: results from the cancer of the prostate strategic urologic research endeavour database. J Urol 165:851–856

    Article  PubMed  CAS  Google Scholar 

  43. Campbell SC, Klein EA, Levin HS, Piedmonte MR (1995) Open pelvic lymph node dissection for prostate cancer: a reassessment. Urology 46:352–355

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Urs E. Studer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bhatta Dhar, N., Burkhard, F.C. & Studer, U.E. Role of lymphadenectomy in clinically organ-confined prostate cancer. World J Urol 25, 39–44 (2007). https://doi.org/10.1007/s00345-007-0149-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-007-0149-8

Keywords

Navigation