Pelvic Lymph Node Dissection
Organ-confined prostate cancer or lymph node metastasis?
It is very important to know whether the lymph nodes contain tumour metastases in order to select the best form of treatment for you. If this is the case, your disease is no longer in an early stage and can only be cured completely in rare cases. Unfortunately, computer tomography (CT) and magnetic resonance imaging (MRI) are of very limited value for detecting microscopic infestation of the lymph nodes.
In the case of an increased risk of lymph node infestation, which is nowadays predictable in advance, lymph node tissue can be removed and examined by means of a small operation. This risk of lymph node infestation depends on certain criteria (tumour stage, PSA value and Gleason score of the tumour). The operation can be performed by means of a small abdominal incision or laparoscopically and means a hospital stay of several days. The side effects are very small. Lymph node tissue is removed at precisely defined locations and examined under the microscope by a pathologist.
However, thanks to modern forms of radiation therapy, the irradiation field can nowadays be defined so precisely and limited to the lymphatic drainage paths that the possible side effects could be extremely reduced. For this reason, patients with a high risk profile today tend to safely irradiate the tissue outside the prostate gland and the Lymph Node Dissection is usually unnecessary.
Patients with an early tumor stage (< cT2b), a PSA value < 10 ng/ml and Gleason Score < 6 can do without lymph node removal anyway.