Indications for Pelvic Lymphadenectomy

Pelvic lymph node dissection (PLND) at time of radical prostatectomy remains an essential component of the surgical management for clinically localized prostate cancer. Nonetheless, abundant literature suggests that PLND is not necessary in all patients. In that regard, nomograms and risk stratification tables are available to better guide appropriate utilization of lymphadenectomy. For patients with a higher-predicted risk of lymph node involvement, PLND (particularly use of extended templates) can identify lymph node metastasis with resultant timely incorporation of adjuvant therapies. While diagnostic in nature, the true therapeutic benefit of PLND in such patients remains unclear with future investigation necessary. Noninvasive imaging likely will play a key role in preoperative risk stratification to better guide the need and role of PLND at the time of prostatectomy.