NCCN Guidelines for Patients
Prostate Cancer, Version 1.2016
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
Pelvic lymph node dissection
A PLND (
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