(UroToday.com) Minh Nguyen, MS2, from the Brody School of Medicine at East Carolina University, presented findings on the evolving trends in pelvic lymph node dissection (PLND) during radical prostatectomy. Her study examined how clinical practice patterns shifted following the 2007 AUA guideline revision, which recommended a more selective approach to PLND in prostate cancer patients.
Nguyen and her team utilized data from the National Cancer Database (NCDB), identifying male patients over 18 years old with nonmetastatic prostate cancer who underwent radical prostatectomy between 2004 and 2020. Patients diagnosed in 2007 were excluded to account for a washout period following the guideline change. Stratification was based on Gleason score into low-risk (6), intermediate-risk (7), and high-risk (8+) groups. Statistical analyses included logistic regression to assess PLND use and Poisson regression to examine the extent of lymph node dissection.
A total of 560,769 men met the inclusion criteria, including 84,431 cases diagnosed pre-guideline and 476,338 cases post-guideline. Following the 2007 revision, overall PLND rates significantly increased from 79% to 88% (p<0.001), and the median number of lymph nodes examined rose from 3 to 5 (p<0.001). As shown in Figure 1, the predicted probability of PLND use steadily increased post-guideline for intermediate- and high-risk groups. Notably, there was no significant change in PLND rates for low-risk patients, remaining at 74% before and after the guideline revision (p=0.231).
Prior to the 2007 guideline update, a gradual decline in PLND use was observed across all risk groups. After the revision, however, PLND utilization began trending upward across all groups, adjusting for the initial decline, with annual incidence rate ratios (IRRs) of 1.06, 1.04, and 1.03 for low-, intermediate-, and high-risk groups, respectively. Additionally, as shown in Figure 2, the median number of lymph nodes examined increased consistently across all risk groups after 2007.
During the Q&A session, a moderator inquired about the parallel increase in PLND among low-risk patients. Specifically, they questioned whether financial incentives, such as relative value units (RVUs), might have contributed to this trend. Nguyen responded that while the 2007 AUA guideline revision was important, broader shifts—such as the 2012 USPSTF recommendation for PSA screening—may have influenced patient selection and surgical practices for low-risk patients and explains the similarity of trends.
An audience member also asked about the potential impact of newer imaging modalities, such as PET scanning, on lymph node dissection practices. Nguyen explained that advanced imaging technologies could guide surgical planning, and that applying the current trends would benefit patients, in particular by better identifying high-risk patients who may fail post-operatively or experience biochemical recurrence.
Figure 1. Predicted Probability of PLND Use by Risk Group and Year of Diagnosis
Figure 2. Predicted Number of Nodes Examined by Risk Group and Year of Diagnosis
Presented by: Minh Nguyen, MS2, Brody School of Medicine at East Carolina University
Written by: Seyedamirvala Saadat B.S., Research Specialist at Department of Urology, University of California Irvine, @Val_Saadat on X during the American Urological Association's 2025 Annual Meeting, between April 26 – 29, 2025 in Las Vegas, NV.