Left untreated, prostate cancer is likely to spread to the lymph nodes surrounding the prostate gland, such as the pelvic area. Patients with prostate cancer may undergo a pelvic lymphadenectomy to remove these lymph nodes in order to determine whether or not they contain cancerous cells.
Pelvic lymphadenectomy, or pelvic lymph node dissection (PLND), is typically done during a radical prostatectomy, but it can also be performed as a separate procedure before scheduling radiation therapy. There are many factors that need to be weighed before determining whether or not this procedure is necessary, including the stage of prostate cancer the patient is currently in:
- Patients in a low risk group or early stages of localized prostate cancer may not need this procedure.
- Patients in a high risk group, with a PSA of 10.5 ng./ml. or greater, a Gleason score of 7 and up, and in later stages of cancer should consider this procedurei.
Extended Pelvic Lymph Node Dissection
As with many prostate cancer treatment options, a pelvic lymphadenectomy comes with complications, and the list only grows with the extent of the dissection. This is why the procedure is only recommended for patients with an increased risk of the cancer metastasizing in the lymph nodes. Once the procedure is extended past the external area of the lymphatic gland, a greater risk arises. However, the more lymph node metastases collected, the better.
While a pelvic lymphadenectomy alone has not been found to be sufficient treatment for prostate cancer, there have been cases where patients prolonged their survival after undergoing a lymphadenectomy and radical prostatectomyii.
According to the Department of Urology of Vita-Salute University in Milan, Italy, "Pelvic lymph node dissection (PLND) is considered the most reliable procedure for the detection of lymph node metastases in prostate cancer." While studies are still being conducted to test the "therapeutic benefit of PLND." survival rates are still high for patients with a low number of nodal metastases detectediii.