Is extended pelvic lymph node dissection REALLY required for staging of prostate cancer in the PSMA-PET era?
Matthew J. Roberts, John Yaxley, Johan Stranne, Inge M. van Oort, Derya Tilki
Abstract
An extended pelvic lymph node dissection (ePLND) at time of radical prostatectomy remains a recommended approach by most international prostate cancer guidelines. Enthusiasts for ePLND argue that it provides optimal staging compared to any imaging with possible oncological benefit and helps patient selection for early salvage therapies. The overall benefit of ePLND to a patient, when balancing the risks of complications and the absence of level 1 evidence of improved long term prostate cancer specific survival outcomes is uncertain. However, does knowledge of some, but not all, pelvic lymph node histopathology (N-stage) following an ePLND REALLY justify the additional risks?