title: Overtreatment of prostate cancer may be prevented by extended pelvic lymphadenectomy.
abstract: OBJECTIVE
  Pelvic lymphadenectomy remains the gold standard for providing a diagnosis of lymph node metastasis (N1) in prostate cancer patients who may be candidates for curatively intended radiotherapy (RT). The limited lymphadenectomy technique (L-PLND) provides removal of only a minority of lymph nodes within the expected regions of lymph node drainage of the prostate. We describe our extended lymphadenectomy (e-PLND) and the pathological outcome with a modified template as described by Briganti and compare it with L-PLND.
  
  
  METHODS
  This was a retrospective study of 44 patients who underwent e-PLND and 36 patients who underwent L-PLND. The lymph node dissection regions were divided into: I the external iliac field, II the obturator field and III the internal iliac field.
  
  
  RESULTS
  The mean age was 70.2 years for e-PLND and 68.9 years for L-PLND. There was no significant difference in preoperative prostate-specific antigen (PSA), Gleason score or clinical stage between the two cohorts of patients. The mean operative time was 95 min. (range 75-140 min.) for e-PLND and 82 min. (range 30-145 min.) for L-PLND (p = 0.03). N1 was found in 18 (41%) and six (17%) in e-PLND versus L-PLND, respectively (p = 0.03). Six of the 44 (13.6%) patients who underwent e-PLND had N1 exclusively outside the region related to the limited dissection technique.
  
  
  CONCLUSIONS
  e-PLND is safe and can prevent overtreatment of at least 13.6% of the prostate cancer patients who may be candidates for RT. Positive needle-core biopsies have a direct impact on N1.
  
  
  BACKGROUND
  not relevant.
  
  
  BACKGROUND
  not relevant.
authors.affiliation: Department of Urology D, Roskilde Hospital, Roskilde, Denmark. nesa@regionsaelland.dk
authors.forename: Nessn H
authors.initials: NH
authors.lastname: Azawi
authors.forename: Katrine
authors.initials: K
authors.lastname: Stenfeldt
authors.forename: Tom
authors.initials: T
authors.lastname: Christensen
mesh_terms: D000368:Aged; D006801:Humans; D007902:Length of Stay; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D061646:Operative Time; D010388:Pelvis; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000532:radiotherapy; D012189:Retrospective Studies; D018570:Risk Assessment
chemical_list: D017430:Prostate-Specific Antigen