Pelvic Lymph Node Dissection in Prostate Cancer: Evidence and Implications

IF 25.3 1区医学 Q1 UROLOGY & NEPHROLOGY

European urology Pub Date : 2025-04-07 DOI:10.1016/j.eururo.2025.03.004

Matthew J. Roberts, Giorgio Gandaglia, Daniela E. Oprea-Lager, Johan Stranne, Philip Cornford, Derya Tilki

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引用次数: 0

Abstract

Section snippets

Why perform pelvic lymph node dissection?

Pelvic lymph node dissection (PLND) performed during radical prostatectomy (RP) has been recommended for many years by international guidelines, including previous editions of the EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines, for staging purposes and a potential oncological benefit. An extended PLND (ePLND) template detects more metastases than a standard template and so is recommended by the guidelines when PLND is deemed necessary. ePLND staging information can ideally assist with postoperative

Patient selection for PLND

Validated nomograms based on preoperative information have been used to individualise patient selection for ePLND for more than 20 yr to overcome the limitations of conventional imaging (CT, magnetic resonance imaging [MRI]) in terms of sensitivity. Different nomogram cutoffs have been proposed to maximise capture of patients who are likely to have pN1 disease while trying to avoid routine PLND in all patients. Historically, nomogram cutoff ranges of 5–7% were proposed and could result in

The 2024 EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines Panel position

The prior “strong” recommendation to perform ePLND because of its ability to accurately stage disease was revisited following review of the available evidence and consideration of risk/benefit ratio. The change in recommendation in 2024 was driven in part by the decision to recommend PSMA PET for staging assessment of patients before treatment. PSMA PET/CT is highly specific but with a negative predictive value of approximately 80% [9], [10], where most of missed metastases are low volume

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来源期刊

European urology 医学-泌尿学与肾脏学

CiteScore

43.00

自引率

2.60%

发文量

1753

审稿时长

23 days

期刊介绍： European Urology is a peer-reviewed journal that publishes original articles and reviews on a broad spectrum of urological issues. Covering topics such as oncology, impotence, infertility, pediatrics, lithiasis and endourology, the journal also highlights recent advances in techniques, instrumentation, surgery, and pediatric urology. This comprehensive approach provides readers with an in-depth guide to international developments in urology.