www.kjurology.org DOI:10.4111/kju.2011.52.7.437 Review Article Role of Pelvic Lymph Node Dissection in Prostate Cancer Treatment Jae Young Joung, In-Chang Cho, Kang Hyun Lee Center for Prostate Cancer, National Cancer Center, Goyang, Korea Pelvic lymph node dissection (PLND) is the most accurate and reliable staging proce- dure for detecting lymph node invasion (LNI) in prostate cancer. Recently, [11C]-choline positron emission tomography imaging and magnetic resonance imaging with lympho- tropic superpara-magnetic nanoparticles have shown potential for detecting LNI but are still under investigation. The risk of LNI in low-risk groups could be underestimated by use of the current nomograms, which rely on data collected from patients who under- went only limited PLND. Extended PLND (ePLND) shows higher lymph node yield, which leads to the removal of more positive nodes and fewer missed positive nodes. It may be possible to refrain from performing PLND on low-risk patients with a pros- tate-specific antigen value ＜10 ng/ml and a biopsy Gleason score ≤6, but the risk of biopsy-related understaging should be kept in mind. Theoretically, meticulous ePLND may also impact prostate cancer survival by clearing low-volume diseases and occult micrometastasis even in pN0. The therapeutic role of PLND in prostate cancer patients is still an open question, especially in individuals with low-risk disease. Patients with intermediate- to high-risk disease are more likely to benefit from ePLND. Key Words: Lymph node dissections; Prostate cancer; Prostatectomy This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is prop erly cited. Article History: received 11 February, 2011 accepted 7 March, 2011 Corresponding Author: Kang Hyun Lee Center for Prostate Cancer, National Cancer Center, 111, Jungbalsan-ro, Ilsandong-gu, Goyang 410-769, Korea TEL: +82-31-920-1676 FAX: +82-31-920-1790 E-mail: uroonco@ncc.re.kr INTRODUCTION Radical prostatectomy and pelvic lymph node dissection (PLND) and removal are important treatment options for men with clinically localized prostate cancer. The prog- nostic significance of lymph node (LN) metastases is well established [1-4]. Pelvic LN metastasis is a strong prog- nostic factor for disease progression and survival. Initially, PLND was performed in all patients during radical prosta- tectomy. Historically, men who underwent surgery for clin- ically localized prostate cancer have a 20% to 40% preva- lence of pelvic LN involvement [5,6]. With the advent of prostate-specific antigen (PSA) testing and more wide- spread prostate cancer screening programs since 1987, this rate has now decreased to 4% to 6% [7,8]. Currently, the ob- jective of a staging lymphadenectomy is to identify micro- metastatic spread to LNs for prognostic evaluation and to identify patients with LN metastasis who would benefit from immediate androgen deprivation therapy [9]. 　At present, some urologists apply well-known nomo- Korean Journal of Urology Ⓒ The Korean Urological Association, 2011 grams when they determine the need for PLND during rad- ical prostatectomy [10-15]. Such nomograms help to identi- fy those patients who need staging PLND but not when per- forming radical prostatectomy. However, the diagnostic accuracy of the nomograms and their safety from an onco- logic perspective are still unknown because of the lack of prospective randomized clinical trials. In contrast, others favor performing PLND in all patients for whom a radical prostatectomy is truly indicated [16]. To clarify this con- fusion, the present study reviewed the available current literature on PLND to determine appropriate PLND candi- dates, the optimal extent of PLND, and the clinical benefits of PLND. CLINICAL STGING FOR LYMPH NODE METASTASES Despite advances in radiological technology, conventional computed tomography (CT) and magnetic resonance imag- ing (MRI) are generally unreliable in detecting LN meta- 437 Korean J Urol 2011;52:437-445