Can sentinel lymph node dissection be used to identify patients who could benefit from further therapy?

The aim of the study was to examine if sentinel lymph node dissection (SLND) could be used to select patients with prostate cancer who would benefit from further pelvic radiation therapy and long-term androgen deprivation therapy (ADT). It was concluded that SLND could be used as a tool to determine whether patients should have more radiation therapy and ADT.

The lymph nodes (organs near the prostate that cancer can spread to) can be used to determine the outcome for a prostate cancer (PC) patient. If cancer has not spread to the lymph nodes there is a good chance of survival. This is known as node negative PC. If it has spread to the lymph nodes this chance is reduced. This is known as node positive PC. Men with node positive PC could benefit from further treatment, such as radiation therapy or ADT. ADT reduces the level of male sex hormones, such as testosterone, involved in cancer growth.

SLND is the surgical removal of lymph nodes nearest to the prostate. It is not known whether SLND could help determine which patients would benefit from pelvic radiation therapy and ADT. 

224 men with PC underwent SLND. 42% were found to have lymph node involvement. Men who had node positive PC were offered were offered radiation therapy and ADT. The 5-year biochemical recurrence free rate (BCR) and the metastasis free survival rate (MFS) were measured for both groups. Biochemical recurrence is a rise in the level of PSA (prostate specific antigen, a protein produced during PC). The MFS is the survival time without the cancer spreading.

For the node negative PC group, the BCR was 67.9% and the MFS was 87.8%. For the node positive PC group, the BCR was 43% and the MFS was 66.6%. Lymph node status and PSA levels were both predictive of BCR and MFS.

This study concluded that SLND can be used to select patients that would benefit from further treatment with pelvic radiation therapy and ADT. 

Further studies will have to be done to confirm the usefulness of SLND. 

Consult your physician about SLND.