Pelvine Lymphadenektomie und radikale Prostatektomie

Abstract

Radical prostatectomy is the most frequently used treatment for localized prostate cancer. In contrast to other strategies radical prostatectomy has been shown to be superior to watchful waiting in a prospective randomized trial. According to the German S3 guideline patients have to be informed about the results of this trial prior to treatment decision. The aims and quality indicators of radical prostatectomy include--as has also been defined by the German Cancer Society for certified prostate cancer centers--complete removal of the prostate with negative surgical margins (R0) and preservation of continence as well as potency. In low-risk disease (according to D'Amico criteria) pelvic lymph node dissection may be abandoned. If lymphadenectomy is performed a minimum number of ten nodes should be obtained. An extended lymphadenectomy is recommended in locally advanced disease.Radical prostatectomy is a valid treatment option in locally advanced prostate cancer. In cases with Gleason score > or = 8 or clinical stage cT3/4 magnetic resonance imaging of the pelvis should be performed prior to treatment decision making. In patients undergoing radical prostatectomy (neo) adjuvant treatment should not be used (exception: adjuvant treatment for lymph node metastases). For the first time the German S3 guideline determines minimum surgery volumes aimed at quality assurance. Radical prostatectomy has to be performed under the supervision of an experienced surgeon. This includes the number of 50 prostatectomies per year and institution, 25 prostatectomies per surgeon, and an appropriate training program.

Robotic perineal radical prostatectomy in a patient with a pre-existing three piece inflatable penile prosthesis

“…There are various opinions about the necessity of lymphadenectomy in intermediate-risk disease. Lymphadenectomy should be performed in every patient with a Gleason 4 pattern according to the German S3 guideline 13 . However, according to the 2019 EAU guideline, lymphadenectomy should be performed if the estimated positive lymph node risk exceeds 5 % in intermediate-risk disease 14 .…”

Multiparametric prostate MRI and structured reporting: benefits and challenges in the PI-RADS era

“…As highlighted in a recent meta-analysis, PSMA-PET/CT demonstrates a high sensitivity and high specificity of up to 77% and 97% for advanced PCa detection in a per-patient analysis [43]. Nevertheless, the detection rate for LN metastases through PSMA-PET/CT in a primary staging setting prior to radical prostatectomy also reveals moderate success rates with sensitivities of 33-65% and specificities of 98-100%, respectively [44].…”