Extended pelvic lymph-node dissection is independently associated with improved overall survival in patients with prostate cancer at high-risk of lymph-node invasion.
Sood A, Keeley J, Palma-Zamora I, Dalela D, Arora S, Peabody JO, Rogers CG, Montorsi F, Menon M, Briganti A, and Abdollah F. Extended pelvic lymph-node dissection is independently associated with improved overall survival in prostate cancer patients at high-risk for lymph-node invasion. BJU Int 2020.
It is generally agreed upon that extended pelvic lymph-node dissection (ePLND) provides valuable staging information and helps guide adjuvant therapy, and should be undertaken in prostate cancer (CaP) patients with aggressive preoperative disease features at the time of radical prostatectomy [1, 2]. However, whether it has a 'direct' therapeutic benefit in the aforesaid patients has remained difficult to demonstrate . The only patients that seem to derive a survival advantage from ePLND are patients with pN1 disease  - this cited study suggested a direct therapeutic effect of ePLND, with a 7% incremental benefit in 10-year cancer-specific survival per every additional lymph-node removed (p=0.02). However, it did not identify these patients preoperatively.
ePub ahead of print