Examining the association between real-world extended vs. standard pelvic lymph node dissection and early and late oncologic outcomes in men undergoing radical prostatectomy

Authors

  • Wyatt MacNevin Dalhousie University, Department of Urology, Halifax, Nova Scotia, Canada
  • Sandra Seo Young Kim Dalhousie University, Department of Urology, Halifax, Nova Scotia, Canada
  • Jesse T.R. Spooner Dalhousie University
  • Ricardo A. Rendon Dalhousie University, Department of Urology, Halifax, Nova Scotia, Canada
  • Hamidreza Abdi University of Ottawa, Division of Urology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  • Rodney H. Breau University of Ottawa, Division of Urology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  • Jonathan Izawa Western University, Division of Urology, London, Ontario, Canada
  • Fred Saad Department of Surgery/Urology, Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, Quebec, Canada
  • Alan I. So Department of Urologic Sciences, University of British Colombia, Vancouver, British Columbia, Canada
  • Bobby Shayegan Division of Urology, McMaster University, Hamilton, Ontario, Canada
  • Ross J. Mason Dalhousie University, Department of Urology, Halifax, Nova Scotia, Canada

DOI:

https://doi.org/10.5489/cuaj.9213

Keywords:

Prostate Cancer, Lymph Node Dissection, Biochemical Recurrence, Metastasis, metastatic castration-sensitive prostate cancer

Abstract

INTRODUCTION: In patients with prostate cancer (PCa), the impact of extended pelvic lymph node dissection (E-PLND) during radical prostatectomy (RP) on oncologic outcomes remains controversial. This study examined the association between extended vs. standard PLND (S-PLND) and biochemical recurrence (BCR), an early outcome, as well as metastatic PCa (mPCa), and castration-resistant PCa (CRPC) development, late outcomes, in a multiinstitutional cohort.

METHODS: High-risk post-RP patients from a Canadian PCa database were analyzed from January 1, 2005, to December 31, 2016. The association between PLND and BCR, mPCa, and CRPC development and complication rate was examined using regression and correlation analysis.

RESULTS: Data were collected from patients who underwent S-PLND (n=494) and E-PLND (n=107). The median followup was 40.1 months, and time to BCR, mPC, and CRPC development was 9.8, 46.0, and 52.1 months, respectively. The median (interquartile range) number of lymph nodes extirpated was 7 (7) and 14 (11) for the S-PLND and E-PLND groups, respectively. E-PLND was associated with increased intraoperative blood loss and higher postoperative complication rate. There were no differences in BCR-free survival based on PLND approach, with 67.1% of S-PLND cases and 71.1% of E-PLND cases reaching BCR-free survival at the end of the followup period (hazard ratio [HR] 0.784 [0.506, 1.215], p=0.28). PLND extent was not a predictor for mPCa progression (p=0.963). Similarly, there were no differences in CRPC-free survival based on dissection type (S-PLND 90.9% vs. E-PLND 89.1%, p=0.561). Lymph node positivity was predictive of BCR, mPCa, and CRPC progression.

CONCLUSIONS: E-PLND did not show significant differences in the rates of BCR, mPCa, or CRPC progression when compared to S-PLND. E-PLND was associated with higher complication rates. This study adds to the data exploring the association between PLND and PCa oncologic outcomes.

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Published

2025-08-28

How to Cite

MacNevin, W., Kim, S. S. Y., Spooner, J. T., Rendon, R. A., Abdi, H., Breau, R. H., … Mason, R. J. (2025). Examining the association between real-world extended vs. standard pelvic lymph node dissection and early and late oncologic outcomes in men undergoing radical prostatectomy. Canadian Urological Association Journal, 19(12), 379–86. https://doi.org/10.5489/cuaj.9213

Issue

Vol. 19 No. 12 (2025): CUAJ December

Section

Original Research

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