Extended lymph node dissection should be performed as part of surgery for high and intermediate risk prostate cancer
Over the past 5-10 years a trend has emerged in favor of performing extended lymph node dissection in intermediate (Gleason 3+4, 4+3) an high risk (Gleason 8-10) prostate cancer or when the PSA >10 ng/mL. The extended dissection includes much more lymph gland removal around the common iliac artery, the lateral pelvic side wall, beneath the obturator nerve as well as the standard external iliac region. The benefits are removing more lymph nodes, giving therefore better staging information, possibly removing occult micrometastatic disease in some cases, and lastly covering a wider landing area where tumor spread was previously not thought to have travelled to and therefore in standard dissections would have been a missed landing zone. The disadvantages are longer operative time, higher risk of complications such as bleeding, lymph collections, ureteric or nerve or vascular injury.