Pelvic Lymph Node Dissection in Prostate Cancer: Is It Really Necessary? A Multicentric Longitudinal Study Assessing Oncological Outcomes in Patients With Prostate Cancer Undergoing Pelvic Lymph Node Dissection vs Radical Prostatectomy Only
With the availability of prostate-specific membrane antigen positron emission tomography scans, it is controversial whether pelvic lymph node dissection (PLND) at the time of radical prostatectomy (RP) is still the most reliable and accurate staging modality for lymph node assessment. Furthermore, t...
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| Published in: | The Journal of urology Vol. 214; no. 2; p. 188 |
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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01.08.2025
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| ISSN: | 1527-3792 |
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| Abstract | With the availability of prostate-specific membrane antigen positron emission tomography scans, it is controversial whether pelvic lymph node dissection (PLND) at the time of radical prostatectomy (RP) is still the most reliable and accurate staging modality for lymph node assessment. Furthermore, the oncological benefit of PLND remains unclear. The aim of this study was to assess whether omitting PLND in patients undergoing RP for prostate cancer (PCa) is associated with the risk of tumor recurrence and progression to metastasis.
In this longitudinal multicenter cohort study, we reviewed data of 2346 consecutive patients with PCa who underwent RP with (n = 1650) and without (n = 696) extended PLND between January 1996 and December 2021. Recurrence-free survival and metastasis-free survival (MFS) were analyzed as a time-to-event outcome using Kaplan-Meier analyses with log-rank tests. To assess the effect of PLND, we created multivariable Cox proportional hazards models adjusting for relevant clinical and demographic characteristics.
Median follow-up was 44 months. There was no difference in recurrence-free survival between men who had a PLND and those who did not (HR, 1.07, 95% CI, 0.87-1.32,
= .52). Patients with D'Amico high-risk disease (PSA >20 µg/L and/or International Society of Urological Pathology grade group ≥4) demonstrated a significantly prolonged MFS if they underwent PLND (HR, 0.57, 95% CI, 0.36-0.91,
= .02). PLND also improved MFS in patients with intermediate-risk disease (HR, 0.48, 95% CI, 0.25-0.90,
= .023). Further significant prognostic variables for MFS on multivariable Cox proportional hazards regression were PSA, International Society of Urological Pathology grade group, and pathological T-stage.
PLND improves MFS in patients with D'Amico intermediate-risk and high-risk PCa and may therefore be considered in men undergoing RP. |
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| AbstractList | With the availability of prostate-specific membrane antigen positron emission tomography scans, it is controversial whether pelvic lymph node dissection (PLND) at the time of radical prostatectomy (RP) is still the most reliable and accurate staging modality for lymph node assessment. Furthermore, the oncological benefit of PLND remains unclear. The aim of this study was to assess whether omitting PLND in patients undergoing RP for prostate cancer (PCa) is associated with the risk of tumor recurrence and progression to metastasis.
In this longitudinal multicenter cohort study, we reviewed data of 2346 consecutive patients with PCa who underwent RP with (n = 1650) and without (n = 696) extended PLND between January 1996 and December 2021. Recurrence-free survival and metastasis-free survival (MFS) were analyzed as a time-to-event outcome using Kaplan-Meier analyses with log-rank tests. To assess the effect of PLND, we created multivariable Cox proportional hazards models adjusting for relevant clinical and demographic characteristics.
Median follow-up was 44 months. There was no difference in recurrence-free survival between men who had a PLND and those who did not (HR, 1.07, 95% CI, 0.87-1.32,
= .52). Patients with D'Amico high-risk disease (PSA >20 µg/L and/or International Society of Urological Pathology grade group ≥4) demonstrated a significantly prolonged MFS if they underwent PLND (HR, 0.57, 95% CI, 0.36-0.91,
= .02). PLND also improved MFS in patients with intermediate-risk disease (HR, 0.48, 95% CI, 0.25-0.90,
= .023). Further significant prognostic variables for MFS on multivariable Cox proportional hazards regression were PSA, International Society of Urological Pathology grade group, and pathological T-stage.
PLND improves MFS in patients with D'Amico intermediate-risk and high-risk PCa and may therefore be considered in men undergoing RP. |
| Author | Sathianathen, Niranjan J Dundee, Philip Kiss, Bernhard Soliman, Christopher Murphy, Declan G Bishop, Conrad Furrer, Marc A Zargar, Homi Thalmann, George N Lawrentschuk, Nathan Liodakis, Peter Rodriguez Calero, Jose Antonio Goad, Jeremy Corcoran, Niall Mulholland, Clancy J Rao, Ranjit Hovens, Christopher M Peters, Justin S Thomas, Benjamin C Costello, Anthony J Steiner, Daniel Moon, Daniel Papa, Nathan Katsios, Andreas Tong, Raymond |
| Author_xml | – sequence: 1 givenname: Marc A surname: Furrer fullname: Furrer, Marc A organization: Department of Urology, Solothurner Spitäler AG, Kantonsspital Olten, and Bürgerspital Solothurn, Solothurn, Switzerland – sequence: 2 givenname: Niranjan J surname: Sathianathen fullname: Sathianathen, Niranjan J organization: Epworth Healthcare, Melbourne, Victoria, Australia – sequence: 3 givenname: Clancy J surname: Mulholland fullname: Mulholland, Clancy J organization: Epworth Healthcare, Melbourne, Victoria, Australia – sequence: 4 givenname: Nathan surname: Papa fullname: Papa, Nathan organization: Department of Surgery, University of Melbourne, Parkville, Victoria, Australia – sequence: 5 givenname: Andreas surname: Katsios fullname: Katsios, Andreas organization: Department of Urology, University of Bern, Bern, Switzerland – sequence: 6 givenname: Christopher surname: Soliman fullname: Soliman, Christopher organization: Epworth Healthcare, Melbourne, Victoria, Australia – sequence: 7 givenname: Nathan surname: Lawrentschuk fullname: Lawrentschuk, Nathan organization: Epworth Healthcare, Melbourne, Victoria, Australia – sequence: 8 givenname: Justin S surname: Peters fullname: Peters, Justin S organization: Epworth Healthcare, Melbourne, Victoria, Australia – sequence: 9 givenname: Homi surname: Zargar fullname: Zargar, Homi organization: Epworth Healthcare, Melbourne, Victoria, Australia – sequence: 10 givenname: Anthony J surname: Costello fullname: Costello, Anthony J organization: Australian Prostate Centre, North Melbourne, Victoria, Australia – sequence: 11 givenname: Christopher M surname: Hovens fullname: Hovens, Christopher M organization: Australian Prostate Centre, North Melbourne, Victoria, Australia – sequence: 12 givenname: Peter surname: Liodakis fullname: Liodakis, Peter organization: Epworth Healthcare, Melbourne, Victoria, Australia – sequence: 13 givenname: Conrad surname: Bishop fullname: Bishop, Conrad organization: Department of Urology, Western Health, Footscray, Victoria, Australia – sequence: 14 givenname: Ranjit surname: Rao fullname: Rao, Ranjit organization: Epworth Healthcare, Melbourne, Victoria, Australia – sequence: 15 givenname: Raymond surname: Tong fullname: Tong, Raymond organization: Epworth Healthcare, Melbourne, Victoria, Australia – sequence: 16 givenname: Daniel surname: Steiner fullname: Steiner, Daniel organization: Epworth Healthcare, Melbourne, Victoria, Australia – sequence: 17 givenname: Declan G surname: Murphy fullname: Murphy, Declan G organization: Genitourinary Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia – sequence: 18 givenname: Daniel surname: Moon fullname: Moon, Daniel organization: Genitourinary Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia – sequence: 19 givenname: Benjamin C surname: Thomas fullname: Thomas, Benjamin C organization: Australian Prostate Centre, North Melbourne, Victoria, Australia – sequence: 20 givenname: Philip surname: Dundee fullname: Dundee, Philip organization: Australian Prostate Centre, North Melbourne, Victoria, Australia – sequence: 21 givenname: Jeremy surname: Goad fullname: Goad, Jeremy organization: Genitourinary Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia – sequence: 22 givenname: Jose Antonio surname: Rodriguez Calero fullname: Rodriguez Calero, Jose Antonio organization: Institute of Pathology, University of Bern, Bern, Switzerland – sequence: 23 givenname: Bernhard surname: Kiss fullname: Kiss, Bernhard organization: Department of Urology, University of Bern, Bern, Switzerland – sequence: 24 givenname: George N surname: Thalmann fullname: Thalmann, George N organization: Department of Urology, University of Bern, Bern, Switzerland – sequence: 25 givenname: Niall surname: Corcoran fullname: Corcoran, Niall organization: Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia |
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| Keywords | oncological outcomes staging modalities radical prostatectomy pelvic lymph node dissection recurrence-free survival metastatic-free survival |
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| SubjectTerms | Aged Disease-Free Survival Humans Longitudinal Studies Lymph Node Excision - methods Lymph Node Excision - statistics & numerical data Lymph Nodes - pathology Lymph Nodes - surgery Lymphatic Metastasis Male Middle Aged Neoplasm Recurrence, Local - epidemiology Neoplasm Staging Pelvis Prostatectomy - methods Prostatic Neoplasms - mortality Prostatic Neoplasms - pathology Prostatic Neoplasms - surgery Retrospective Studies |
| Title | Pelvic Lymph Node Dissection in Prostate Cancer: Is It Really Necessary? A Multicentric Longitudinal Study Assessing Oncological Outcomes in Patients With Prostate Cancer Undergoing Pelvic Lymph Node Dissection vs Radical Prostatectomy Only |
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