PELVIC LYMPHADENECTOMY IN THE PROSTATE CARCINOMA AND ITS LIMITS

Czech version

Authors: MUDr. Michal Staník
Authors‘ workplace: Urologická klinika LF MU a FN Brno pracoviště Bohunice
Published in: Urol List 2006; 4(4): 14-18

Overview

The article provides an overview of current knowledge of the indications for, and the extent and benefit of pelvic lymphadenectomy in prostate cancer. With the onset of PSA screening, the rate of lymph node metastases in radical prostatectomy has sharply declined. Some recent studies indicate that the reported results may be underrated due to a limited extent of pelvic lymphadenectomy. By extending lymphadenectomy to internal iliac lymph nodes more lymph node metastases could be obtained, and available data indicate that the procedure can improve the prognosis of the patient. However, there is still controversy as to the indication of lymphadenectomy, as the majority of patients do not need it. New nomograms based on data from extended lymphadenectomy have been developed to better predict the probability of lymph node metastases. The concept of the sentinel lymph node dissection appears to be an alternative to limited pelvic lymphadenectomy. If the sentinel node is free of tumour cells, further metastases can be excluded and performing extended lymphadenectomy becomes unnecessary.

KEY WORDS:
prostate cancer, radical prostatectomy, limited and extended pelvic, lymphadenectomy, lymph node metastases

Sources

1. Daneshmand S, Quek ML, Stein JP et al. Prognosis of patients with lymph node positive prostate cancer following radical prostatectomy: long-term results. J Urol 2004; 172: 2252-2255.

2. Skinner DG. Management of invasive bladder cancer: a meticulous pelvic node dissection can make a difference. J Urol 1982; 128: 34-36.

3. Allaf ME, Palapattu GS, Trock BJ et al. Anatomical extent of lymph node dissection: impact on men with clinically localized prostate cancer. J Urol 2004; 172: 1840.

4. Bader P, Buckhard FC, Markwalder R, Studer UE. Disease progression and survival of patients with positive lymph nodes after radical prostatectomy. Is there a chance of cure? J Urol 2003; 169: 849-854.

5. Cerny J, Farah R, Rian R et al. An evaluation of lymphangiography in staging carcinoma of the prostate. J Urol 1975; 113: 367.

6. DelRegato J, Ackermann L. Diagnosis, treatment and prognosis of cancer. 4th ed. St Louis: Mosby 1977: 654.

7. Golimbu M, Morales P, Al-Askari S and Brown J. Extended pelvic lymphadenectomy for prostatic cancer. J Urol 1979; 121: 617.

8. Heidenreich A, Varga Z, Von Knobloch R. Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis. J Urol 2002; 167: 1681.

9. Stone NN, Stock RG, Unger P. Laparoscopic pelvic lymph node dissection for prostate cancer: comparison of extended and modified techniques. J Urol 1997; 158: 1891-1894.

10. Schumacher M, Burkhard F, Thalmann G, Fleischmann A, Studer U. Is pelvic lymph node dissection necessary in patients with a serum PSA < 10ng/ml undergoing radical prostatectomy for prostate cancer? Eur Urol 2006; 50: 272-279.

11. Wawroschek F, Vogt H, Weckermann D et al. Radioisotope guided pelvic lymph node dissection for prostate cancer. J Urol 2001; 166: 1715-1719.

12. Briganti A, Chun F, Salonia A et al. Complications and other surgical outcomes associated with extended pelvic lymphadenectomy in men with localized prostate cancor. Eur Urol 2006; 50: 1006-1013.

13. Jeschke S, Nambirajan T, Leeb K et al. Detection of early lymph node metastases in prostate cancer by laparoscopic radioisotope-guided sentinel lymph node dissection. J Urol 2005; 173: 1943-1946.

14. Di Blasio CJ, Fearn P, Seo HS et al. Association between number of lymph nodes removed and freedom from disease progression in patients receiving pelvic lymph node dissection during radical prostatectomy. J Urol 2003; 169: 456(A1708).

15. Bader P, Spahn M, Huber R et al. Limited lymph node dissection in prostate cancer may miss lymph node metastasis and determines outcome of apparently pN0 prostate cancer. Eur Urol 2004; 3: 16(A55).

16. Weingartner K, Ramaswamy A, Bittinger A et al. Anatomical basis for pelvic lymphadenectomy in prostate cancer: results of an autopsy and implications for the clinic. J Urol 1996; 156: 1969.

17. Bader P, Burkhard FC, Markwalder R, Studer UE. Is a limited lymph node dissection an adequate staging procedure for prostate cancer. J Urol 2002; 168: 514-518.

18. Briganti A, Chun F, Salonia A et al. Validation of a nomogram predicting the probability of lymph node invasion among patients undergoing radical prostatectomy and an extended pelvic lymphadenectomy. Eur Urol 2006; 49: 1019.

19. Bochner BH, Herr HW, Reuter VE. Impact of separate versus en bloc pelvic lymph node dissection on the number of lymph nodes retrieved in cystectomy specimens. J Urol 2001; 166: 2295.

20. Bhatta-Dhar N, Reuther A, Zippe C, Klein E. No difference in six-year biochemical faiulure rates with or without pelvic lymph node dissection during radical prostatectomy in low-risk patients with localized prostate cancer. Urology 2004; 63: 528.

21. Grossfeld GD, Chang JJ, Broering JM, Li Y et al. Understaging and undergrading in a contemporary series of patients undergoing radical prostatectomy: results from the cancer of the prostate strategic urologic research endeavour database. J Urol 2001; 165: 851-856.

22. Rigatti P, Chun F, Salonia A et al. A Nomogram for staging of exclusive nonobturator lymph node metastases in men with localized prostate cancer. Eur Urol 2006, v tisku.

23. Palapattu GS, Allaf ME, Trock BJ, Epstein JL and Walsh PC. Prostate specific antigen progression in men with lymph node metastases following radical prostatectomy: results of long-term followup. J Urol 2004; 172: 1860.

24. Messing E, Manola J, Sarosdy M. Immediate hormonal therapy compared with observation after radical prostatectomy and pelvic lymphadenectomy in men with node-positive prostate cancer. New Engl J Med 1999; 341: 1781.

Labels

Paediatric urologist Urology

WHAT'S NEW IN PROSTATE CANCER PATHOLOGY ASSESMENT IN 2006

LYMPHATIC DRAINAGE OF THE PROSTATE

PSA AND EARLY DETECTION OF PROSTATE CARCINOMA

PATHOLOGY OF THE PROSTATE AND ANDROGEN AND ESTROGEN LEVELS

EVIDENCE-BASED CLINICAL APPROACH TO ANDROGEN SUPPRESSION AND RADIOTHERAPY IN MALE PATIENTS WITH LOCALLY ADVANCED OR LOCALIZED CARCINOMA OF THE PROSTATE

Article was published in

Urological Journal

2006 Issue 4