Prostate Cancer Questions and Answers: when are lymph node removed?

Dr. Simon Hall: What would be the indications for doing a pelvic lymphadenectomy and when exactly in the course of the prostatectomy, would you do that procedure?

Dr. Samadi: So I usually remove the lymph node dissections at the end of the case, unless there is a really bulky lymph node at the beginning of the case and I grew up on the mentality that even if you see a microscopic positive lymph node to remove the prostate because the bulk in the prostate would cure these patients and they would be able to prevent them from having the consequences of having urethral obstructions.

The lymph nodes are usually removed on patients with Gleason-7 and higher. One can argue and it takes only about 5-10 minutes and it's not an issue. It's mostly for staging purposes, not for curative and for Gleason-6, one can argue whether it should be removed or not.


The rate of positive lymph node with Gleason-6 is really in 1% to 2% and the risk of any kind of complication by removing the lymph nodes such as lymphoceles or nerve damage is also about that percent. So if a patient is really asking for it, one can remove it. It doesn't add much to the surgery and it's really not a big issue with robotic prostatectomy.


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