The role of radical prostatectomy and lymph node dissection in lymph node-positive prostate cancer: A systematic review of the literature

Georgios Gakis, Stephen A. Boorjian, Alberto Briganti, Steven Joniau, Guram Karazanashvili, R. Jeffrey Karnes, Agostino Mattei, Shahrokh F. Shariat, Arnulf Stenzl, Manfred Wirth, Christian G. Stief

Research output: Contribution to journalArticlepeer-review

Abstract

Context Because pelvic lymph node (LN)-positive prostate cancer (PCa) is generally considered a regionally metastatic disease, surgery needs to be better defined. Objective To review the impact of radical prostatectomy (RP) and pelvic lymph node dissection (PLND), possibly in conjunction with a multimodal approach using local radiotherapy and/or androgen-deprivation therapy (ADT), in LN-positive PCa. Evidence acquisition A systematic Medline search for studies reporting on treatment regimens and outcomes in patients with LN-positive PCa undergoing RP between 1993 and 2012 was performed. Evidence synthesis RP can improve progression-free and overall survival in LN-positive PCa, although there is a lack of high-level evidence. Therefore, the former practice of aborting surgery in the presence of positive nodes might no longer be supported by current evidence, especially in those patients with a limited LN tumor burden. Current data demonstrate that the lymphatic spread takes an ascending pathway from the pelvis to the retroperitoneum, in which the internal and the common iliac nodes represent critical landmarks in the metastatic distribution. Sophisticated imaging technologies are still under investigation to improve the prediction of LN-positive PCa. Nonetheless, extended PLND including the common iliac arteries should be offered to intermediate- and high-risk patients to improve nodal staging with a possible benefit in prostate-specific antigen progression-free survival by removing significant metastatic load. Adjuvant ADT has the potential to improve overall survival after RP; the therapeutic role of a trimodal approach with adjuvant local radiotherapy awaits further elucidation. Age is a critical parameter for survival because cancer-specific mortality exceeds overall mortality in younger patients (

Original languageEnglish
Pages (from-to)191-199
Number of pages9
JournalEuropean Urology
Volume66
Issue number2
DOIs
Publication statusPublished - 2014

Keywords

  • Androgen-deprivation therapy
  • Imaging
  • Lymph node positive metastasis
  • Multimodality
  • Pelvic lymph node dissection
  • Prostate cancer
  • Radical prostatectomy
  • Radiotherapy

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

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