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February 5, 2026

Pelvic lymph node dissection during radical prostatectomy for prostate cancer: harms versus benefits.

Key Points

To evaluate the risks and benefits of pelvic lymph node dissection during radical prostatectomy in prostate cancer patients.
Included cN0M0 prostate cancer patients who underwent radical prostatectomy between January 2013 and February 2023.
Categorized patients into groups based on whether they received pelvic lymph node dissection or not.
Assessed perioperative and oncological outcomes using multivariate analysis and Cox regression.
Group A had higher complication rates (58.3% linked to PLND) and longer surgery times.
No significant differences in 4-year biochemical recurrence-free survival between groups (68.9% vs. 75.4%).
Positive surgical margins and tumor grade were significant risk factors for biochemical recurrence, while PLND did not impact this.

Abstract

Introduction: This study aimed to evaluate the harms and oncological benefits of pelvic lymph node dissection (PLND) during radical prostatectomy (RP) in prostate cancer patients at risk for regional lymph node invasion (LNI). Methods: Patients with cN0M0 prostate cancer who underwent RP between January 2013 and February 2023 were included. Patients were categorized into two groups: 334 patients who underwent RP with PLND (group A) and 161 without PLND (group B). Perioperative and oncologic outcomes were assessed, and multivariate analysis identified independent prognostic factors. Inverse Probability of Treatment Weighting (IPTW) was applied to account for baseline differences. Results: Group A had more advanced disease, longer operation times, and higher complication rates, with 58.3% of complications related to PLND. After a median follow-up of 56 months, there were no significant differences in 4-year biochemical recurrence-free survival (BRFS)(68.9% vs. 75.4%), metastasis-free survival, or overall survival between the groups. Positive surgical margins and tumor grade were independent risk factors for biochemical recurrence, while PLND was not. Cox regression in the IPTW-adjusted cohort confirmed no significant impact of PLND on BRFS (HR 0.70, p=0.09) Conclusion: PLND during RP increases postoperative complications without improving short-term oncologic outcomes, serving mainly as a staging procedure to inform management.

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