Table of Contents Author Guidelines Submit a Manuscript
Advances in Urology
Volume 2012, Article ID 983058, 6 pages
http://dx.doi.org/10.1155/2012/983058
Review Article

Sense and Nonsense of an Extended Pelvic Lymph Node Dissection in Prostate Cancer

1Department of Urology, University Hospitals Leuven, 3000 Leuven, Belgium
2Department of Urology, Clinique Mutualiste de la Loire, 42013 Saint-Etienne, France
3Department of Urology, University of Würzburg, 97070 Würzburg, Germany
4Department of Urology, Vita-Salute University, 20132 Milan, Italy
5Department of Urology, University of Turin, 10129 Turin, Italy

Received 14 June 2011; Accepted 12 August 2011

Academic Editor: Hein Van Poppel

Copyright © 2012 Anthony Van Baelen et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Lymph node metastases associated with prostate cancer (PCa) has been shown to be a poor prognostic factor. The role of pelvic lymph node dissection (PLND) itself in relation to survival remains unclear, however. A Medline search was conducted to address this issue. The following conclusions were drawn. Only recently, improved survival due to completion of radical prostatectomy (RP) (compared to abandoning RP) in known or presumed lymph-node-positive patients has been shown. Lymph node sampling can only be considered representative if an adequate number of nodes is removed. While several authors have suggested that a therapeutic benefit in patients undergoing RP is not provided by PLND, the reliability of these studies is uncertain. Contrary to this, several studies have indicated the possibility of long-term survival even in the presence of limited lymph node metastases. The role and timing of initiation of adjuvant androgen deprivation therapy (ADT) in patients who have node-positive disease after RP is controversial. Recent studies suggest that delaying ADT may not adversely impact survival.