Is there a role for pelvic lymphadenectomy before radiation therapy in localized prostate carcinoma?

Pelvic nodal irradiation has classically been recommended in all patients with a predicted lymph node invasion risk of 15% or greater. However, in view of the results of recent series of extended lymphadenectomy, this rule has been critically discussed. Moreover, the technological progress of radiotherapy has drastically decreased the risk of rectal and urinary injuries secondary to the pelvic irradiation. These two points have lead the teams who used to perform a staging lymphadectomy before radiation therapy in order to avoid a useless pelvic irradiation to the N0 patients, to question this attitude. The objective of this review is to discuss these points and to present the clinical situations in which a pelvic lymphadenectomy performed before the irradiation of a prostate cancer, either exclusive or associated to an androgen deprivation, keeps a potential benefit.