Extended versus Limited Lymphadenectomy in High-Risk Prostate Cancer: What is the Current Evidence?

• Alexandre Dib Partezani ^[2] ; Luís Cesar Zaccaro Silva ^[3] ; Francisco Sérgio Moura Silva do Nascimento ^[4] ; Natália Dalsenter Avilez ^[5] ; Leonardo O. Reis ^[1] ; Marcelo Langer Wroclawski ^[6]
  1. [1] Pontifícia Universidade Católica de Campinas

     Pontifícia Universidade Católica de Campinas

     Brasil

     
  2. [2] Urology Department, Hospital Israelita Albert Einstein, São Paulo, SP 05652-900, Brazil
  3. [3] Urology Department, Santa Casa de Misericórdia de Ribeirão Preto, Ribeirão Preto, SP 14085-000, Brazil
  4. [4] UroScience Department, UNICAMP-Universidade Estadual de Campinas, Campinas, SP 13083-894, Brazil; Urology Department, Federal University of Maranhão, São Luís, MA 65080-805, Brazil; INCT UroGen, National Institute of Science, Technology and Innovation in Genitourinary Cancer (INCT), Campinas, SP 13087-571, Brazil
  5. [5] UroScience Department, UNICAMP-Universidade Estadual de Campinas, Campinas, SP 13083-894, Brazil; INCT UroGen, National Institute of Science, Technology and Innovation in Genitourinary Cancer (INCT), Campinas, SP 13087-571, Brazil
  6. [6] Urology Department, Hospital Israelita Albert Einstein, São Paulo, SP 05652-900, Brazil; Urology Department, BP-a Beneficência Portuguesa de São Paulo-São Paulo, São Paulo, SP 01323-000, Brazil; Urology Department, Faculdade de Medicina do ABC-Santo André, Santo André, SP 09060-650, Brazil

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• Localización: Archivos españoles de urología, ISSN 0004-0614, Tomo 78, Nº. 8, 2025, págs. 939-947
• Idioma: inglés
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  • Background: Radical prostatectomy is a common treatment option for patients with prostate cancer (PCa). In patients with a high-risk disease, the association of pelvic lymphadenectomy is recommended. This review aimed to address the main aspects of performing pelvic lymphadenectomy, including extension and anatomical aspects, number of lymph nodes (LNs) dissected, staging and presurgical planning, nomograms, benefits, and complications, in patients with high-risk PCa.

    Methods: We conducted a narrative review using English articles from the MEDLINE/PubMed database. The articles were selected because of their high level of evidence and importance, and we utilized the following expressions and combinations of terms: “high-risk prostate cancer”, “pelvic lymph node dissection”, “lymphadenectomy” and “radical prostatectomy”.

    Results: LN involvement in patients with PCa is an independent risk factor for poor prognosis, and this procedure increases the risk of perioperative morbidity. Extended pelvic LN dissection is indicated in high-risk patients, and nomograms are useful in determining whether LN dissection should be performed because of the risk of LN involvement. Determining whether the rate of complications increases during the procedure is important.

    Conclusions: In high-risk PCa, extended pelvic LN dissection promotes local staging better than that achieved through limited pelvic LN dissection and new imaging methods at the expense of increased risk of complications.