Extended pelvic lymphadenectomy does not improve biochemical recurrence in high-risk prostate cancer patients treated with robot-assisted radical prostatectomy: a propensity-matched comparison of two institutions

Abstract Background Pelvic lymph node dissection in intermediate- or high-risk localized prostate cancer is important for detecting or eliminating lymph node metastases. This study evaluates the effectiveness of extended pelvic lymph node dissection (ePLND) for high-risk prostate cancer. Methods We identified 275 patients who underwent robot-assisted radical prostatectomy for high- or very high-risk prostate cancer, as defined by the National Comprehensive Cancer Network risk categories, at two centers between May 2013 and March 2021. Using propensity score matching, 61 patients from each group were compared between the no ePLND and ePLND groups. Console time, estimated blood loss, surgery-related complications, and biochemical recurrence (BCR) rates were compared between the groups. Multivariate analysis was used to identify independent predictors of BCR. Results The ePLND group had longer operative and console times and greater blood loss compared with the no ePLND group (P < .01). Intraoperative surgery-related complications were also more frequent in the ePLND group (P = .01); however, no significant difference was observed in postoperative surgery-related complications (P = .28). The median follow-up period was 60 months; BCR rates were not different between the groups (P = .12). However, in a sub-analysis limited to very high-risk cases, the BCR in the no ePLND group was significantly higher than in the ePLND group (P = .01). Multivariate analysis identified pathologic T stage ≥3 and lymphovascular invasion as independent predictors of BCR, whereas ePLND was not associated with BCR. Conclusions In this study, ePLND for high- or very high-risk prostate cancer did not improve BCR. However, it may improve BCR in very high-risk prostate cancer.