Unilateral Pelvic Lymph Node Dissection in Prostate Cancer Patients Diagnosed in the Era of Magnetic Resonance Imagingetargeted Biopsy - A Study That Challenges the Dogma

Sep 24, 2026

Unilateral extended pelvic lymph node dissection (ePLND) is evaluated for prostate cancer patients staged in the modern pathway using first MRI and subsequent MRI-targeted biopsy plus targeted random sampling. Current models for lymph node invasion (LNI) show limited specificity because up to 70% of removed nodes test negative. The study assesses feasibility, reports rarity of contralateral LNI linked to tumor grade and extent, and proposes an LNI prediction model to support omitting contralateral ePLND in selected patients. Limitations include multi-institutional variability in MRI acquisition, reporting, biopsy, and lack of external validation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Study Need and Importance

What We Found

Limitations

Interpretation for Patient Care

[www.auajournals.org/journal/juro](www.auajournals.org/journal/juro) JU Insight Unilateral Pelvic Lymph Node Dissection in Prostate Cancer Patients Diagnosed in the Era of Magnetic Resonance Imagingetargeted Biopsy: A Study That Challenges the Dogma Alberto Martini , Lieke Wever, Timo F. W. Soeterik, et al. Correspondence: Massimo Valerio (email: [massimo.valerio@hcuge.ch](massimo.valerio@hcuge.ch)). Full-length article available at [https://doi.org/10.1097/JU.0000000000003442](https://doi.org/10.1097/JU.0000000000003442). Study Need and Importance: The currently available clinical models for lymph node invasion (LNI) prediction are hampered by a relatively low speciﬁcity, the removed lymph nodes being negative up to 70% of the time. Up to 2016, prostate cancer (PCa) clinical staging was based mostly on digital rectal examination and prostatic biopsy according toprespeciﬁed templates, also referred to as “random”biopsy. Since then, the diagnostic pathway for prostate cancer has changed and currently consists in MRI ﬁrst with subsequent targeted biopsy of the suspicious areas of the prostate along with random sampling of the gland. This represents a major step forward in managing PCa; the use of preoperative MRI provides surgeons with seminal staging information. To our knowledge, this is the ﬁrst study to assess the feasibility of unilateral extended pelvic lymph node dissection (ePLND) in the era of modern PCa imaging. What We Found: LNI contralateral to the prostatic lobe with worse tumor characteristics is rare and depends on the presence of cancer contralateral to the dominant side, its grade, and extent. Our ﬁndings provide the grounds for evaluating unilateral ePLND in future studies. Limitations: The multi-institutional nature of our data might harbor a certain degree of unaccounted heterogeneity, especially concerning MRI acquisition, reporting, and biopsy together with the lack of external validation. Figure. Distribution of contralateral lymph node metastases according to International Society of Urological Pathology (ISUP) grade on the dominant and contralateral sides in the absence of high-risk clinical features (prostate-speciﬁc antigen 􀀁20 ng/mLand/or extraprostatic extension or seminal vesicle invasion on multiparametric magnetic resonance imaging and/or grade group 􀀁4) . LNI indicates lymph node invasion; neg, negative. Interpretation for Patient Care: In the era of modern PCa imaging, ePLND can be omitted contralateral to the prostatic lobe with the worse tumor burden in selected patients, especially in the absence of high-risk clinical features. We propose a model for the prediction of LNI contralateral to the dominant prostate lobe that can help avoid contralateral ePLND in almost onethird of cases. Potential beneﬁts of our model in clinical practice could be shorter operative time and lower risk of complications and costs (see Figure). THE JOURNAL OF UROLOGY® 􀀁 2023 The Author(s) . Published on behalf of the American Urological Association, Education and Research, Inc. [https://doi.org/10.1097/JU.0000000000003442](https://doi.org/10.1097/JU.0000000000003442)[ ](https://doi.org/10.1097/JU.0000000000003442)Vol. 210, 117-127, July 2023 Printed in U.S.A. [www.auajournals.org/jurology](www.auajournals.org/jurology j 117)[ j](www.auajournals.org/jurology j 117)[ 117](www.auajournals.org/jurology j 117) [www.auajournals.org/journal/juro](www.auajournals.org/journal/juro) Unilateral Pelvic Lymph Node Dissection in Prostate Cancer Patients Diagnosed in the Era of Magnetic Resonance Imagingetargeted Biopsy: A Study That Challenges the Dogma Alberto Martini ,1 Lieke Wever,2,3 Timo F. W. Soeterik,2 Arnas Rakauskas,4 Christian Daniel Fankhauser,5 Josias Bastian Grogg,5 Enrico Checcucci,6 Daniele Amparore,6 Luciano Haiquel,7 Lara Rodriguez-Sanchez,7 Guillaume Ploussard,1 Peng Qiang,8 Andres Affentranger,8 Alessandro Marquis,9 Giancarlo Marra,9 Otto Ettala,10 Fabio Zattoni,11,

FAQs

Why is lymph node invasion prediction difficult in prostate cancer staging?

Existing clinical models have limited specificity, with removed lymph nodes negative up to 70% of the time.

What does the study report about contralateral lymph node invasion?

Contralateral LNI to the worse tumor side is rare and depends on cancer presence on the contralateral side, along with grade and extent.

How might the proposed model change patient care?

It supports avoiding contralateral ePLND in about one-third of cases lacking high-risk clinical features, potentially reducing operative time, complications, and costs.

Sep 24, 2026

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