The Evolution of Staging of Lymph Node Metastases in Clinically Localized Prostate Cancer{A figure is presented}

Objectives: We performed a systematic literature review of the staging of pelvic lymph node metastases in clinically localized prostate cancer. Methods: The description of the evolution of the staging paradigms of lymph node invasion (LNI) in localized prostate cancer is based on a systematic review of the English language literature on this topic. Results: A single randomized trial addressing pelvic lymph node dissection (PLND) exists and no Cochrane review covers the topic of lymph node staging in localized prostate cancer. Most publications are based on retrospective analyses, including some large multicenter validation studies. The available reports demonstrate that extended PLND improves staging and that ideally 30 lymph nodes should be removed. This represents a shift away from either no PLND or very limited PLND, in historic series. However, not all men need to be subjected to an extended PLND. At least some patients can be effectively staged with limited PLND. Conclusions: This review illustrates the evolution of lymph node staging in prostate cancer, which changed from no staging through limited staging to extended staging. This review provides evidence-based criteria for identifying patients at risk of LNI, as well as for defining the extent of PLND, when indicated.