Is the number of lymph nodes removed during PLND related to the prevalence of lymph node invasion?

Karim Touijer

This article has no abstract so we have provided the first paragraph of the full text.

The downward stage migration seen in patients with prostate cancer has led a number of surgeons to forego PLND during radical prostatectomy.¹ The anatomical limits of PLND for prostate cancer have "shrunk" over the years.² Many reports criticize this "minimalist" approach, suggesting that lymph node metastases in prostate cancer are underestimated. Briganti and colleagues report that the likelihood of detecting nodal metastases increases as the number of nodes retrieved during PLND increases. This confirms what has been demonstrated by others—that a thorough and carefully executed operation will lead to better staging and therapeutic benefit in a select group of patients. It has been demonstrated that, in patients with negative nodes, the total number of nodes removed affects the biochemical recurrence-free probability,³ which highlights that the incidence of lymph node metastasis in clinically localized prostate cancer is underestimated by the limitations of surgical staging and routine pathological examination. Immunohistochemistry and real-time-PCR-based assays for PSA and prostate-specific membrane antigen have shown superiority over routine hematoxylin and eosin stains in detecting nodal metastasis.⁴ Furthermore, nodal metastases detected by these assays carry a prognostic significance.

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