Long-term results from the phase 3 NCT01812902 tria suggest that extended pelvic lymph node dissection (ePLND) during radical prostatectomy may provide a significant survival benefit for patients with high-grade prostate cancer.
The study enrolled 300 men with intermediate- or high-risk prostate cancer and followed them for a median of nearly 11 years. While extended lymph node removal identified substantially more patients with lymph node metastases than limited dissection (17% vs. 3.4%), no significant differences in recurrence, metastasis-free survival, or overall survival were observed across the entire study population.
However, among patients with high-grade disease (ISUP Grade Group 3–5), ePLND reduced the risk of metastasis by 74% and significantly improved biochemical recurrence-free survival compared with limited dissection. Patients in the extended-dissection group also required fewer additional treatments such as radiation therapy or hormone therapy.
The broader surgical approach was associated with longer operations, greater blood loss, longer hospital stays, and more postoperative complications, including lymphoceles. Investigators said the findings support the use of extended lymph node dissection in selected high-risk patients and align with current 2026 AUA/ASTRO guideline recommendations.