Sentinel node biopsy in combination with extended pelvic lymph node dissection for men with prostate cancer at risk of nodal involvement

Initial diffusion of prostate cancer (PCa) occurs in the regional lymph node (LN) stations. Positive LNs represent a significant adverse prognostic factor in PCa and can be associated with systemic metastases (1,2). Several anatomic studies with extensive lymphadenectomy have demonstrated that the obturator fossa is not always the primary site for LNs metastasis: therefore, pelvic LN dissection (LND) limited to the obturator fossa can miss about 50% of LN metastases. Therefore, an extended pelvic LN dissection (ePLND) should be performed in all intermediate-high-risk PCa, while a limited LND should be avoided, for the high risk of missing at least half the nodes involved (3).