Localized prostate cancer or lymph node involvement? 

Lymph node dissection provides prognostic information, it influences the design of the subsequent therapeutic strategy and it provides information necessary to compare the results of various therapeutic strategies To decide for the most beneficial type of treatment, it is essential to know whether lymph node metastasis are present. If this is the case, the cancer is no longer in an early stage and is only curable in rare cases. Unfortunately, CT scan, MRI, ultrasound, and ileopelvic scintigraphy, have so far proven to be of very limited value, because of their low specificity and sensitivity. 

In cases, which with today’s screening methods predict an increased risk of lymph node metastasis, lymph node tissue should be removed for evaluation by means of a minor surgery. This lymph node metastasis risk depends on certain criteria. (stage of the tumor, PSA score, and Gleason score). The surgery is performed by making a small incision into the lower abdomen, or in some cancer centers, it will be performed laparoscopically. The patient will have to remain in the hospital for several days. The side effects of the surgery are minor. Lymph node tissue is taken from previously exactly defined areas, and then evaluated by a pathologist under the microscope. If the pathologist does not find any indication that the tissue is affected by the tumor, the area to receive radiation can be defined more precisely and kept within the prostate region. This minimizes injury to the surrounding tissue that could possible occurs through the radiation. 

This minor surgery is indicated in each case that evidenced the high risk of a lymph node involvement. For patients with an early-stage tumor (< cT2b), a PSA score of < 10 ng/ml as well as a Gleason score less than 6, a lymph node dissection is not necessary.