ABSTRACT
When and to what extent lymphadenectomy should be performed in patients undergoing radical prostatectomy remains a matter of intense debate. Lymphadenectomy provides important information for prognosis (number of nodes involved, tumor volume, capsular perforation) that is not matched by any other procedures. Whether, in addition, a potential therapeutic effect of extended lymph node dissection with removal of all diseased nodes can be expected has still not been fully documented, due to the relatively benign course of this disease. In contrast, in other malignancies such as gastric, breast, colorectal, and cervical cancer, and in recent years also bladder cancer, it has become apparent that survival and accuracy of staging improve with the number of nodes removed and therefore the extent of lymph node dissection.1-6
Precise tumor staging is the basis for optimal therapeutic management. In prostate cancer the availability of biochemical markers and preoperative biopsies allows a differentiated staging. Based on these, nomograms have been developed to help decide which patients will benefit from pelvic lymphadenectomy and in which it can be avoided.7 To date all nomograms are based on standard lymph node dissection and with the increasing awareness of possible lymph node metastasis outside the region of standard dissection, these nomograms may prove increasingly inadequate.
