Therapeutic value of pelvic lymph node dissection in high-grade prostate cancer

Objective: This study aimed to assess the therapeutic value of pelvic lymph node dissection (PLND) in high-grade margin-negative prostate cancer without and with lymph node metastases. Methods: We retrospectively reviewed cases in the Western Australian radical prostatectomy (RP) database between January 1, 2010, and December 31, 2017. We identified men who had RP only (no PLND) and those had RP with PLND. Further, a subset of high-grade (Gleason score (GS) ⩾8) margin-negative cancers were identified. We assessed the therapeutic impact of PLND in this high-risk but potentially curable subset. Results: A total of 5648 prostatectomies were performed, and 1209 of these had concurrent PLND, negative surgical margins, and follow-up prostate-specific antigen (PSA) data. Of 558 men with high-grade margin-negative prostate cancer, 395 men had PLND, while 163 did not. There were significantly more patients with T3/T4 disease in the PLND group compared to those without PLND. Preoperative PSA did not differ significantly between the two groups. However, when stage matched, PLND had no impact on the numbers of men who were cured compared to those who failed surgical intervention. Conclusion: PLND has value in staging high-grade prostate cancer but has limited impact on producing a durable PSA cure or avoiding adjuvant therapy. Level of evidence: Not applicable for this multicenter audit.