![]() Using a false-positive rate of 3%, Bluestein et al. Currently, PLND is not carried out in patients deemed to be at low risk for lymph node metastasis. Essentially, these cut-offs would define an acceptable percentage of patients with potentially detectable metastatic disease who would nevertheless undergo radical prostatectomy. Others have proposed PSA and Gleason score cut-off points for selecting patients in whom the risk of nodal disease is low, obviating the need for PLND. Multiple models and nomograms combining PSA, clinical stage and Gleason score have been developed to predict the probability of metastatic disease. ![]() The advent of prostate specific antigen (PSA) screening and increased clinical awareness have led to considerable stage migration and a low incidence of lymph node involvement in contemporary radical prostatectomy series. Reported complications of PLND are obturator nerve injury, trauma to major vessels, thromboembolic events, lymphocoele formation, chronic lower extremity and genital edema and infection. PLND is an expensive, invasive procedure, with attendant complications, and appears to have no therapeutic value. However, there has been recent interest in identifying patients for whom lymph node dissection may not be justified on the basis of cost and potential morbidity. Pathological examination of lymph node tissue remains the gold standard for determining whether or not lymph node metastases are present. PLND has traditionally been an integral component of prostate (pelvic) cancer staging.
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