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MINERVA UROLOGICA E NEFROLOGICA
A Journal on Nephrology and Urology
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,536
Minerva Urologica e Nefrologica 2007 March;59(1):53-7
Lymph node disease after radical prostatectomy
Wirth M. P., Froehner M.
Department of Urology University Hospital Carl Gustav Carus Technical University of Dresden Dresden, Germany
Most patients with lymph node involvement at radical prostatectomy are destined to experience disease progression. Since the detection rate of lymph node metastases depends on the extension of lymphadenectomy, comparison between series may be biased and there is no generally accepted treatment approach. Although one small randomized study demonstrated a survival benefit for patients receiving immediate hormonal treatment compared with treatment onset at clinical progression, in patients with minimal lymph node involvement the benefit of immediate treatment is uncertain. It is possible that treatment onset at PSA relapse is sufficient in such cases thus sparing side effects and costs of hormonal treatment. The role of adjuvant radiotherapy is unclear in patients with lymph node involvement at radical prostatectomy. Since spread into the lymph nodes in most cases indicates systemic disease, local measures only are unlikely to cure those patients. Possibly, in select cases, adjuvant radiotherapy may improve local control and maintain quality of life, even if no survival benefit may be expected. Overall, there is a need to enrol patients with lymph node involvement at radical prostatectomy onto clinical studies to improve the body of knowledge on optimal management in these cases.