Is Pelvic Lymph Node Dissection Necessary in Patients with a Serum PSA&lt;10ng/ml Undergoing Radical Prostatectomy for Prostate Cancer?

Schumacher, Martin; Burkhard, Fiona C.; Thalmann, George N.; Fleischmann, Achim; Studer, Urs E.

doi:10.1016/j.eururo.2006.01.061

Cited by 96 publications

(62 citation statements)

References 23 publications

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“…Even strong PLND advocates concede that in these select patients it may be reasonable to forgo PLND, bearing the caveat that many of these patients are understaged preoperatively. 28,29 The 'Partin tables' were the initial tool constructed to determine the probability of LNI before surgical intervention based on preoperative variables. 30 A common critique of the Partin table prediction of lymph node positivity is that the PLND performed by the Hopkins group would be considered 'standard' or involved only the external iliac and obturator lymph nodes, thus potentially underestimating true lymph node positivity.…”

Section: Patient Selectionmentioning

confidence: 99%

Lymph node dissection during robot-assisted radical prostatectomy: where do we stand?

Silberstein

Derweesh

Kane

2009

Prostate Cancer Prostatic Dis

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Since the initial report of robot-assisted laparoscopic prostatectomy (RALP) in 2001, the technique has gained rapid acceptance and utilization. When compared with more traditional forms of surgical intervention, there is still much debate with respect to cost, and impact on potency and continence. Less often is the focus on oncologic outcomes. Pelvic lymph node dissection (PLND) at the time of prostatectomy is an important part of the surgical intervention for prostate cancer and is currently underreported during robotic procedures. Herein, we review the current controversies on the value and extent of PLND and the status of emerging data regarding robot-assisted PLND. IntroductionRadical prostatectomy has undergone an evolution in technique over many decades with older procedures being largely replaced by newer ones due to perceived superiority of oncologic outcomes or diminution of operative morbidity. [1][2][3] In the United States, da Vinci robot-assisted laparoscopic prostatectomy (RALP) has gained rapid popularity because of the facility with which it allows laparoscopic skills to be transferred to even non-laparoscopically trained surgeons. 4 Thus, the benefits of laparoscopy, enhanced optical magnification, decreased blood loss, and minimal incisions can be obtained without prolonged learning curves. Any time a new technique is introduced, it must be compared with current methods to ascertain at least equivalent outcomes, in addition to assessment of benefits, and limitations. To this end, there have been recent publications from the centers of excellence attempting to compare RALP to radical retropubic and pure laparoscopic techniques. 5,6 However, there has been a paucity of literature addressing pelvic lymph node dissection (PLND) at the time of RALP. This is not the case with all urologic robot-assisted procedures; recent literature on robot-assisted radical cystectomy has specifically focused on feasibility and adequacy of robot-assisted PLND. 7 Thus, the lack of literature on robot-assisted PLND at RALP may reflect that PLND at the time of prostatectomy performed through open technique (or otherwise) is a controversial topic. Important questions remain regarding patient selection, potential benefit and anatomic extent of the dissection, nodal yield, and complication rates. We will review these controversies and the state of the literature regarding RALP PLND in this context. Ongoing controversies in PLNDIn the United States, prostate cancer is the most commonly diagnosed noncutaneous cancer and the second-leading cause of cancer death among men. In 2008, 186 320 men were diagnosed with, and 28 660 men died of, prostate cancer in the United States. 8 The advent of prostate-specific antigen (PSA) screening has led to a profound stage migration such that men diagnosed in the PSA era are younger and have lower clinical and pathologic stage and lower mortality rates, and when treated they have improved margin-free status and biochemical progression-free survival and decreased extracapsular extension a...

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Section: Patient Selectionmentioning

confidence: 99%

Lymph node dissection during robot-assisted radical prostatectomy: where do we stand?

Silberstein

Derweesh

Kane

2009

Prostate Cancer Prostatic Dis

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“…11 These groups's PLND typically yielded 6-9 LNs and therefore may have understaged the patients for a given PSA and Gleason score. Schumacher and colleagues 37 analyzed patients with a PSA less than 10 ng/ml who underwent RRP and PLND, and found positive lymph nodes in 11% of the men. In patients with GS less than or equal to 6, only 3% had positive LNs while 25% of men with pathologic GS 7 or higher had positive nodes.…”

Section: Who Should Undergo Plnd?mentioning

confidence: 99%

Pelvic lymphadenectomy in prostate cancer

Breyer

Greene

Dall′Era

et al. 2008

Prostate Cancer Prostatic Dis

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This review analyzes the anatomy of the prostate gland's lymphatic drainage, the optimal anatomic extend of pelvic lymph node dissection (PLND) and which dissection may be superior, who should undergo a PLND during prostatectomy, and its potential therapeutic benefits and complications. The prostate gland's lymphatic drainage can be variable, but frequently metastatic disease is found in the internal iliac chain. We conclude that the extended PLND yields the most lymph nodes and therefore may be superior. Some have demonstrated an unproven survival benefit after performing an extended PLND, possibly from removal of occult disease or from more accurate staging.Prostate Cancer and Prostatic Diseases (2008) 11, 320-324; doi:10.1038/pcan.2008 published online 20 May 2008 Keywords: pelvic lymph node dissection; lymph nodes; anatomy; radical retropubic prostatectomyThe role of pelvic lymph node dissection (PLND) during radical prostatectomy has generated considerable debate. The central role of a PLND is to determine the locoregional extent of cancer, and to help evaluate the need for adjuvant therapy and the risk of progression and recurrence. Some believe that PLND is therapeutic and promotes a cancer-specific survival benefit. [1][2][3][4] This review aims to critically analyze: (1) the anatomy of the prostate gland's lymphatic drainage, (2) the anatomic boundaries of PLND and which dissection may be superior, (3) who should undergo a PLND during prostatectomy, (4) the potential therapeutic benefits of performing PLND and (5) the complications of PLND. PLND anatomically definedAnatomic studies have been performed to define the periprostatic subcapsular lymphatic network that drains the prostate. 5,6 The network is composed of the ascending, lateral and posterior groups. The ascending ducts drain into the external iliac lymph nodes, the lateral ducts into the hypogastric node chain, and the posterior ducts draining from the caudal prostate to the subaortic lymph nodes of the sacral promontory. 5,6 Weingartner et al. 7 performed extensive PLND on cadavers. A mean lymph node (LN) yield of 20 was found and the authors suggested that this number serve as a guideline for sufficient PLDN. Interestingly, they analyzed prostate cancer patients's LNs and found that they were relatively enlarged, whether they contained cancer or not, compared to non-cancer cadavers.Three approaches to the PLND have been described: limited, standard and extended. 8,9 (Table 1, Figure 1) The exact nomenclature and surgical boundaries of PLND vary between institutions and lack standardization. International consensus on anatomic boundaries and use of descriptive terminology is needed. 9 Standardization would promote uniformity of practice and improve the comparison of future studies on PLND in prostate cancer.What is the optimal anatomic extend of PLND?Considerable debate exists over the appropriate boundaries of PLND during radical retropubic prostatectomy (RRP). Proponents of the extended PLND argue that it significantly increases yield of ...

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“…Recent series of more extended PLND reveal alarmingly higher rates of LNI including one cohort of patients with a PSA<10 having a LNI of 11%. 21 Other extended PLND series in low-risk patients have confirmed LNI rates up to 7.4%. 22,23 This issue is critical to our understanding and subsequent reliance of predictive tools in the surgical management of prostate cancer.…”

Section: Staging Issuesmentioning

confidence: 99%

Why all prostate cancer surgery should include an adequate lymph node dissection

Siemens

2013

CUAJ

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Is Pelvic Lymph Node Dissection Necessary in Patients with a Serum PSA<10ng/ml Undergoing Radical Prostatectomy for Prostate Cancer?

Cited by 96 publications

References 23 publications

Lymph node dissection during robot-assisted radical prostatectomy: where do we stand?

Lymph node dissection during robot-assisted radical prostatectomy: where do we stand?

Pelvic lymphadenectomy in prostate cancer

Why all prostate cancer surgery should include an adequate lymph node dissection

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