Current controversies on the role of lymphadenectomy for prostate cancer

Chalouhy, Charbel; Gurram, Sandeep; Ghavamian, Reza

doi:10.1016/j.urolonc.2018.11.020

Cited by 15 publications

(9 citation statements)

References 50 publications

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“…In this and other trials [28] , if patients are considered for inclusion and therefore local treatment, complete resection or radiation of all present metastatic lesions is pursued. Surgical resection in the form of sePLND or radiation of LN metastasis, however, comes with substantial morbidity [29] . Ideally, previous systemic therapy and accurate imaging would allow optimization of the extent of local therapy.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Optimal Time Point of [68Ga]Gallium-labeled Prostate-specific Membrane Antigen Ligand Positron Emission Tomography Imaging in Patients Undergoing Cytoreductive Surgery After Systemic Therapy for Primary Oligometastatic Prostate Cancer: Implications for Patient Selection and Extent of Surgery

Huebner

Rasul

Baltzer

et al. 2022

European Urology Open Science

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Section: Discussionmentioning

confidence: 99%

Feasibility and Optimal Time Point of [68Ga]Gallium-labeled Prostate-specific Membrane Antigen Ligand Positron Emission Tomography Imaging in Patients Undergoing Cytoreductive Surgery After Systemic Therapy for Primary Oligometastatic Prostate Cancer: Implications for Patient Selection and Extent of Surgery

Huebner

Rasul

Baltzer

et al. 2022

European Urology Open Science

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“…Surgical treatment has been traditionally discouraged in locally advanced PCa. But increasing recent evidence in literature push urologists to operate for RP in cT3 PCa patients assessing no LNI is shown [20] . In terms of whether performing PLND at RP in patients with locally advanced PCa, this is even less reported.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Lymph Node Dissection on Survival in Intermediate- and High-Risk Prostate Cancer: A Population-Based Study

Zhou

Xin

Zhai

et al. 2021

Preprint

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Objective Aimed to evaluate the therapeutic effect of pelvic lymph node dissection (PLND) on survival and determine the predictors of lymph node involvement (LNI) in patients with intermediate- or high-risk prostate cancer (PCa) treated with Radical Prostatectomy (RP).Methods 75,583 patients undergoing RP with or without PLND between 2010 and 2016 were extracted from the Surveillance Epidemiology and End Results database. We performed 1:1 propensity score matching due to potential differences according to the 2 cohorts. Cox regression models (CRMs) were used to test the effect of PLND on overall mortality (OM) and cancer-specific mortality (CSM). Logistic regression analysis was used to investigate the predictors of LNI.Results The propensity-score-matched cohort includes 52,314 patients with or without PLND. Kaplan Meier analysis confirmed that patients receiving PLND had a poorer prognosis than those without PLND (P<0.05). But the multivariable CRMs after adjustment showed that PLND was not an independent predictor for OM and CSM (P>0.05). According to multivariable CRMs, patients with locally advanced PCa in whom PLND was performed had higher OM (HR 1.67, CI 1.36-2.06) and CSM (HR 2.26, CI 1.16-3.12) risks compared to patients without PLND (p < 0.001). Compared to patients with intermediate-risk PCa, there was a higher risk of LNI in patients with locally advanced PCa (OR 16.82, 95% CI 5.05-56.06, P<0.001).Conclusions In the intermediate- or high-risk localised PCa, there was no signiﬁcant difference in survival outcome in patients with or without PLND. Locally advanced PCa was significantly associated with LNI but can’t benefit from PLND.

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“…In particular, the increase in lymphocele is of concern . Therefore, investigation of the optimal extent of lymph node dissection is essential and the morbidity of pelvic lymph node dissection should always be considered, especially when the newly dissected region is anticipated to add little clinical information . A small amount of cancer tissue might be removed with lymph node dissection of the fossa of Marcille.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic and therapeutic value of pelvic lymph node dissection in the fossa of Marcille in patients with clinically localized high‐risk prostate cancer: Histopathological and molecular analyses

et al. 2020

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Background: The optimal extent of lymph node dissection in radical prostatectomy has not been determined. Lymph nodes in the fossa of Marcille, which is an important pelvic lymphatic pathway and candidate for additional dissection, have not been evaluated at the molecular level. Here, we assessed by molecular analysis the presence of occult positive lymph nodes in the fossa of Marcille in patients with clinically localized high-risk prostate cancer.Methods: Fifty-two patients with clinically localized high-risk prostate cancer underwent pelvic lymph node dissection accompanied by robot-assisted radical prostatectomy. All nodal packets were dissected separately and grouped into right and left obturator, external and internal iliac regions (including common iliac region to ureter crossing), and fossa of Marcille. All lymph nodes were bisected and evaluated by histopathological or molecular analysis using a quantitative reverse transcription-polymerase chain reaction. The number of positive lymph nodes in the fossa of Marcille and the difference in detection rate were investigated using histopathological and molecular analyses. Perioperative complication rate and predictive factors for biochemical recurrence were evaluated.Results: In the molecular analysis, there were seven positive lymph nodes in the fossa of Marcille in three patients, which were coexistent with positive nodes in other regions. The detection rate of positive lymph nodes was significantly higher using molecular than histopathological analysis (P < .01). Perioperative complication rate within 90 days after the operation was 25.0% and no Clavien-Dindo grade ≥3 complication was confirmed.Detection of metastasis by histopathological and molecular analysis was a significant factor related to biochemical recurrence in the Cox proportional hazards regression model. Conclusions: No case of positive lymph nodes in the fossa of Marcille that had skipped over other regions was confirmed. Additional lymph node dissection of fossa of Marcille did not lead to complete resection of molecularly positive lymph nodes. K E Y W O R D S lymph node dissection, prostatectomy, reverse transcription-polymerase chain reaction

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Current controversies on the role of lymphadenectomy for prostate cancer

Cited by 15 publications

References 50 publications

The Impact of Lymph Node Dissection on Survival in Intermediate- and High-Risk Prostate Cancer: A Population-Based Study

Diagnostic and therapeutic value of pelvic lymph node dissection in the fossa of Marcille in patients with clinically localized high‐risk prostate cancer: Histopathological and molecular analyses

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