Positive lymph node detection in treatment of prostate cancer: an update


In a major lecture at the European Association of Urology annual meeting in Milan, Dr. Michael Jewett (Toronto) addressed the detection and mapping of regional lymph nodes (LN) in management of genitourinary cancers. 

The occurrence of positive lymph nodes is critical to the diagnosis and staging of patients with prostate cancer (and other forms of genitourinary cancer) because it can be a clear indicator of risk for micrometastatic disease.

Jewett noted that while staging is prognostic and sets the scenario for adjuvant therapy, lymphadenectomy (LA) — the surgical removal of selected lymph nodes — is therapeutic and should be performed in appropriate patients. Dr. Jewett also stated that, in his opinion, CT or MRI are inadequate for staging and should not replace surgical staging.

The bottom line here is that, although good techniques for identifying positive lymph nodes in appropriate patients are still not widely available in general clinical practice, unless lymph node dissection is carried out as a component of a radical prostatectomy, knowing lymph node status in some patinets is critical to both their status and their clinical care. Jewett concluded that surgical mapping remains the standard today, but that newer techniques may eventually have a place in clinical management.

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