EXTENDED pelvic lymph node dissection (PLND) during radical prostatectomy significantly reduces the risk of metastasis in patients with prostate cancer, according to a recent study. Lymph node dissection has been a standard practice in cancer surgery for over a century, yet robust evidence from randomised trials demonstrating its benefits has been limited. This study provides updated findings on biochemical recurrence (BCR) and metastasis rates, offering critical insights into the clinical value of extended PLND.
Between October 2011–March 2017, 1,432 patients undergoing radical prostatectomy were enrolled at a single centre. Surgeons were cluster randomised to perform either limited PLND (external iliac nodes) or extended PLND (external iliac, obturator, and hypogastric nodes), with crossover every three months. Cox proportional-hazards regression, with robust standard errors clustered by surgeon, was used to assess the impact of PLND template on BCR and metastasis rates. At a median follow-up of 4.2 years for BCR and 5.4 years for metastasis, the study confirmed comparable BCR rates between the two groups (hazard ratio [HR]: 1.05, 95% CI: 0.97-1.13; p=0.3). However, extended PLND demonstrated a significant protective effect against metastasis, with a 18% reduction in any metastasis (HR: 0.82, 95% CI: 0.71-0.93; p=0.003) and a 25% reduction in distant metastasis (HR: 0.75, 95% CI: 0.64-0.88; p<0.001).
These findings underscore the clinical importance of extended PLND in reducing metastasis risk during radical prostatectomy. The results suggest that surgeons should prioritise removing nodes from the external iliac, obturator, and hypogastric regions to improve patient outcomes. Future research should explore the biological mechanisms underlying the protective effect of extended PLND and consider applying this clinically integrated trial design to other cancers. This study highlights the need for further randomised trials to refine lymph node dissection practices across oncology.
Katheeja Imani, EMJ.
Reference
Touijer KA et al. Pelvic lymph node dissection in prostate cancer: update from a randomized clinical trial of limited versus extended dissection. European Urology. 2025;87(2):253–60.
