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NCCN Guidelines for Patients


Prostate Cancer, Version 1.2016

Figure 12.

Nomogram results for


Primary tumors that are rated

T1 or T2 have not grown outside

of the prostate. However, the

cancer may have spread to nearby

lymph nodes. To receive the best

treatment, your doctor needs to

know if cancer is present in lymph

nodes. When using a ≥2% risk

cutoff, most men with cancer in

their lymph nodes will be correctly

staged because they received a


4 Overview of cancer treatments

Surgical treatment

Pelvic lymph node dissection









issection) is an

operation that removes lymph nodes from your pelvis.

As described in Part 5, PLND is advised if 1) you

have a T1 or T2 tumor, 2) you choose to have a

prostatectomy, and 3) a nomogram predicts you have

a 2% or greater risk for cancer in your lymph nodes.

Using a 2% cutoff, nearly half of men (48 out of every

100) will be spared having a PLND.

See Figure 12


Also, almost all men in this group who have cancer in

their lymph nodes will be correctly staged and treated.

An extended PLND removes more lymph nodes than

a limited PLND. It finds metastases about two times

as often as a limited PLND. It also stages cancer

more completely and may cure some men with very

tiny metastases that haven’t spread far. Therefore, an

extended PLND is advised if you’re to have a PLND.

It can be done with an open retropubic, laparoscopic,

or robotic method.

Side effects of surgical treatment

Side effects are unhealthy or unpleasant physical

or emotional responses to treatment. You may

experience side effects from the general anesthesia,

prostatectomy, or the PLND. During the operation,

you may have a serious loss of blood and require a

blood transfusion. Serious risks of anesthesia and

prostatectomy include heart attack and blood clots.

After the operation, general anesthesia may cause

a sore throat from a breathing tube, nausea with

vomiting, confusion, muscle aches, and itching. From

the operation, you will have pain and swelling that

often fade away within weeks. The PLND may rarely

cause swelling in the legs due to the buildup of lymph

(lymphedema) that will resolve over several weeks.

Almost every man has urinary incontinence and

erectile dysfunction after a radical prostatectomy.

These two side effects may be short lived, but for