Current status of pelvic lymph node dissection in prostate cancer: the New York PLND nomogram.

INTRODUCTION Controversy persists concerning the role of pelvic lymph node dissection (PLND) in patients with clinically localized prostate cancer undergoing radical prostatectomy. The aim of this review is to critically evaluate the current status on PLND in prostate cancer. METHODS A review of the literature was performed concerning radical prostatectomy and PLND with respect to oncological outcome, associated complications, nodal yield, indications and minimal number of nodes required. RESULTS PLND is still the modality of choice for detecting lymph node metastasis in prostate cancer. Current imaging techniques are not accurate enough for detecting nodal metastases. Extended PLND has complications that increase with extent of dissection. Nodal yield at PLND is directly related to the lymph node invasion (LNI) rate and greater nodal yield is associated with superior staging accuracy. Based on MSKCC nomogram and in conjunction with prospective confirmation studies a novel nomogram (the New York nomogram) was designed. CONCLUSION Removing at least 10 lymph nodes is recommended to detect LNI. For patients with high and intermediate risk disease, extended PLND at least for external iliac, obturator and hypogastric lymph nodes should be performed during radical prostatectomy. However, for patients with low risk disease, PLND is not necessary and is not recommended, because the chance of metastasis is low.