THE ROLE OF LYMPHADENECTOMY IN PROSTATE CANCER PATIENTS/ULOGA LIMFADENEKTOMIJE U BOLESNIKA S KARCINOMOM PROSTATE

Prostate cancer is one of the most important men's health issues in developed countries. For patients with prostate cancer a preoperative staging of the disease must be made. Involvement of lymph nodes could be assessed using imaging methods (CT or/and MRI), however, newer methods also exist (PET/CT, PSMA PET/CT). For some patients during radical prostatectomy a pelvic lymphadenectomy is recommended. Pelvic lymphadenectomy is indicated in intermediate- and high-risk group patients and with increased probability of lymph node invasion. The most used prediction tools for preoperative assessment of lymph nodes are Briganti and MSKCC nomograms and Partin tables. Pelvic lymphadenectomy can include different lymph nodes group, but extended lymphadenectomy is the recommended procedure. In 1-20% of patients, the lymph node invasion is present. Pelvic lymphadenectomy is primarily a diagnostic and staging method, and in minority of patients with positive lymph nodes it can be a curative method, too. In other patients with positive lymph nodes adjuvant therapy (radiotherapy and androgen deprivation therapy) can be beneficial. Key words: Prostate cancer; Radical prostatectomy; Pelvic lymph node dissection; Radiotherapy Karcinom prostate je jedan od znacajnijih zdravstvenih problema muškaraca u razvijenom dijelu svijeta. U bolesnika s dijagnosticiranim karcinomom prostate neophodno je uciniti prijeoperacijsko stupnjevanje bolesti. Zahvacenost limfnih cvorova se standardno odreduje uz pomoc slikovnih metoda (CT i/ili/ MR) iako postoje i novije metode (PET/CT, PSMA PET/CT). U odredenog broja bolesnika prilikom radikalne prostatektomije treba uciniti i zdjelicnu limfadenektomiju. Odluka o potrebi za zdjelicnom limfadenektomijom se donosi na osnovu svrstavanja bolesnika u umjerenu odnosno grupu visokoga rizika i ako je vjerojatnost za zahvacenost limfnih cvorova povecana. Najcešce danas korišteni nomogrami za prijeoperacijsku procjenu zahvacenosti limfnih cvorova su Briganti i MSKCC nomogram te Partin-ove tablice. Zdjelicna limfadenektomija može obuhvacati razlicite skupine limfnih cvorova ali se preporuca uciniti proširenu zdjelicnu limfadenektomiju. U 1-20% bolesnika nalaze se pozitivni limfni cvorovi. Iako zdjelicna limfadenektomija ima prvenstveno dijagnosticki i prognosticki znacaj, u manjeg broja bolesnika s pozitivnim limfnim cvorovima može biti i definitivna terapijska metoda. U ostalih bolesnika s pozitivnim limfnim cvorovima adjuvantna terapija (radioterapija i a