Commentary on: Validation of sentinel lymph node dissection in prostate cancer: experience in more than 2,000 patients

Abstract

Lymph node metastases are one of the most important prognostic factors in prostate cancer. N staging directly influences the treatment decision in patients for whom potentially curative treatments are planned. However, the authors [1] provide a reminder that there is an ongoing debate about which patients require lymph node resection and how the dissection should be extended [2]. The Augsburg group first developed and described sentinel lymphadenectomy (SLNE) in prostate cancer. They have demonstrated through some studies that the majority of sentinel lymph node (SLN) and non-SLN metastases were found along the internal iliac vessels and that limited lymphadenectomy to obturator fossa was clearly insufficient for accurate lymph node staging. These findings are sustained by the majority of studies reporting on extended pelvic lymphadenectomy in prostate cancer. In this study, they reported the largest series with more than 2,000 patients who underwent SLNE alone or in combination with either standard or extended lymphadenectomy. It is the most important published manuscript in the literature. However, this study gathers heterogeneous subgroups of patients. The first goal of the study was to evaluate the