Filing for an extension.

Pelvic lymph node dissection is a standard addition to prostatectomy in order to appropriately stage prostate cancer, but there's no clear consensus of the ideal extent or even whether there is any therapeutic advantage. Here we have what’s called a cluster randomization where 1440 sequential patients received prostatectomy under the management of surgeons who performed alternating limited (external iliac nodes) versus or extended (external iliac, obturator fossa and hypogastric nodes) pelvic lymph node dissections for 3-month periods. In the end, the median number of nodes dissected was hardly different: 12 with limited versus 14 with extended. Similarly, the rate of involved nodes was 12% versus 14%, respectively. Therefore, it’s no surprise there was no difference whatsoever in the primary endpoint of biochemical control at 3 years. The authors conclude a randomized trial should be designed evaluating the therapeutic implications of any pelvic node dissection versus none. | Touijer, Eur Urol Oncol 2021