Critical reviews in oncology hematology vol:78 pages:S16-S17
European School of Oncology - Educational Cancer Lugano Convention Workshop on Whats New and Whats True in Genito-Urinary Oncology? location:Lugano, SWITZERLAND, date:12-14 May 2011
Although the incidence of nodal metastases is now lower
than in the pre PSA era, recent series of extended
lymphadenectomies have shown that the incidence of lymph
node metastases is higher than that observed with standard
obturator lymph node dissection. It is clear that lymph node
metastasis may occur without haematogenous dissemination
in the bone. It was suggested that extended lymphadenectomy
of early stage nodal involvement could offer a survival benefit
similar to that reported in other cancers.
Clinicians today rely on nomograms such as the Partin
tables to estimate the risks of lymph node involvement but
these tables were developed using limited node dissections resulting in an underestimation of the incidence of patients
with positive nodes.
Surgical pelvic lymph node dissection remains the gold
standard for accurate nodal staging. Since only an extended
lymph node dissection ensures a full lymph node staging one
should consider the morbidity that is reported to be 3 times
higher when compared to limited lymph node dissection
(lymphoceles, lymphedema, deep venous thrombosis and
Non-invasive staging modalities with contrast enhanced CT,
CT guided percutaneous fine needle biopsy, MRI and choline
PET scan and more recently sentinel node dissection with
radiocolloids are bringing new hope.
The management of patients with nodal invasion remains
controversial. While in patients with minimal nodal invasion
who underwent an extended lymphadenectomy and have an
undetectable PSA after surgery there is probably no need
for any adjuvant measure, patients with more than 2 nodes
invaded or with capsular perforation might benefit from early adjuvant hormonal manipulation.