The extent of pelvic lymph node dissection (PLND) during prostatectomy is debated within clinical practice. While ePLND provides valuable staging information, its therapeutic benefit remains unproven.
Guidelines vary, with European and National Comprehensive Cancer Network recommending ePLND, while the American Urological Association remains non-specific. ePLND is the most reliable staging procedure, offering detailed prognostic information.
However, it is associated with higher risks of complications such as lymphocele and thromboembolism. The advent of PSMA PET imaging offers superior diagnostic accuracy but is limited in detecting micrometastatic disease.
Ongoing clinical trials aim to clarify the therapeutic benefits of ePLND, considering the impact of advanced imaging techniques.
