The role and controversy of pelvic lymph node dissection in prostate cancer treatment: a focused review

TL;DR

This paper reviews the role of pelvic lymph node dissection in prostate cancer treatment, highlighting its benefits, controversies, and current guidelines.

Contribution

The paper provides a focused review of the current status and controversies surrounding pelvic lymph node dissection in prostate cancer.

Findings

PLND is the gold standard for lymph node staging in prostate cancer despite inconsistent implementation.

There is a lack of high-quality evidence supporting the oncological benefits of PLND.

PLND increases surgical time and risk of complications, contributing to ongoing debates about its therapeutic value.

Abstract

Pelvic lymph node dissection (PLND) is commonly performed alongside radical prostatectomy. Its primary objective is to determine the lymphatic staging of prostate tumors by removing lymph nodes involved in lymphatic drainage. This aids in guiding subsequent treatment and removing metastatic foci, potentially offering significant therapeutic benefits. Despite varying recommendations from clinical practice guidelines across countries, the actual implementation of PLND is inconsistent, partly due to debates over its therapeutic value. While high-quality evidence supporting the superiority of PLND in oncological outcomes is lacking, its role in increasing surgical time and risk of complications is well-recognized. Despite these concerns, PLND remains the gold standard for lymph node staging in prostate cancer, providing invaluable staging information unattainable by other techniques. This article reviews PLND's scope, guideline perspectives, implementation status, oncologic and non-oncologic outcomes, alternatives, and future research needs.