Is There a Need for Pelvic Lymph Node Dissection in Low Risk Prostate Cancer Patients Prior to Definitive Local Therapy?

In men with low risk prostate cancer the need for pelvic lymph node dissection is controversial. Therefore, we examined how many men with favorable preoperative risk factors had positive lymph nodes. 235 men with preoperative PSA ≤10 ng/ml, Gleason score ≤6 and positive biopsies in only one lobe, had radio-guided pelvic sentinel lymph node (SLN) dissection and radical retropubic prostatectomy (RRP) or—in case of no positive lymph nodes detected—a transperineal I 125 seed implantation. Eighty-four men with positive biopsies in both lobes and identical PSA and Gleason score had SLN dissection and RRP. In 187 men with positive biopsies in one lobe RRP was performed. Sixteen patients had positive lymph nodes. Median 6 SLN (mean 6.8) and 6 non-sentinel lymph nodes (NSLN) (mean 7.3) were dissected. All men with positive lymph nodes also had positive SLN. Eighty-four men with positive biopsies in both lobes had RRP. Nine men had positive lymph nodes (10.7%). A median of 6 SLN (mean 6.6) and 5 NSLN (mean 7.5) were dissected. All men with positive nodes had a single positive SLN. In patients with PSA ≤10 ng/ml and biopsy Gleason score ≤6, positive lymph nodes were identified by radio-guided surgery in 6.8% [Wawroschek et al. Urol Int 2003;70:303; Narayan et al. Urology 1994;44:519] (positive biopsies in one lobe) and 10.7% [Wawroschek et al. Urol Int 2003;70:303; Eur Urol 1999;36:595] (positive biopsies in both lobes). Up to 4 positive SLN were found. Therefore, we suggest not to dispense with an operative lymph node staging, even in low risk disease.