What are the effects of radical prostatectomy without pelvic lymph node dissection in prostate cancer?

This study investigated the outcomes of radical prostatectomy (RP) without pelvic lymph node dissection (PLND) in patients with prostate cancer. The main finding was that 5 years after treatment, 100% of patients at low risk for cancer recurrence had survived.

PLND is surgery to remove the lymph nodes from the pelvis. It’s often is used in combination with RP for the treatment of prostate cancer. Cancer cells spread most commonly to the neighbor lymph nodes. PLND is commonly performed to make sure no cancer cells remain. This can minimize the risk of cancer returning.

In early-stage prostate cancer, there is a minimal risk that the cancer cells have spread to the lymph nodes. However, the effects of radical prostatectomy without PLND are not well known. 

This study included the health records of 146 patients with prostate cancer. All patients had received RP  without PLND at the same hospital. The likelihood of prostate cancer recurrence was assessed. Patients who were more than 50% likely to experience cancer spreading to another organ also received androgen deprivation therapy (ADT; hormonal therapy). Prostate-specific antigen (PSA) testing, which is used to diagnose and monitor prostate cancer, was performed at 3-month intervals for the first 2 years after RP. PSA testing was then performed twice a year in the third year after treatment and yearly after that. Patients were followed up for 78.5 months on average.

39 patients were at low risk for recurrence, 59 patients were at medium risk for recurrence, and 48 patients were at high risk for recurrence. 3 patients in the low-risk group developed recurrence. 16 patients in the medium-risk group developed recurrence. 20 patients in the high-risk group developed recurrence.

5 years after treatment, 100% of low-risk patients, 96.3% of medium-risk patients, and 95.7% of high-risk patients had survived. The 5-year cancer-specific survival was 100% for all groups. The factors that predicted a higher risk of relapse were high PSA level before treatment (over 10 ng/ml) and high aggressiveness of cancer measured through the Gleason score (8 or more).

This study suggested that without PLND, RP was a safe and effective treatment for prostate cancer.

This study included patients treated in one hospital only. Therefore, the results may not be applicable to patients treated elsewhere.