Surgery for prostate cancer, known as a radical prostatectomy, involves the removal of the entire prostate gland. If the cancer is more aggressive, it is often necessary to perform an extended pelvic lymphadenectomy as well, which involves removing the pelvic lymph nodes.
However, not all patients have the same risk that the tumor has already spread to the lymph nodes. For this reason,and given that pelvic lymphadenectomy is associated with an increased risk of intra- and postoperative complications, statistical tools—known as risk calculators—have been developed in recent years to help urologists estimate, prior to surgery, the likelihood that the lymph nodes are affected by the disease.
Our researchers analyzed the impact of using these risk calculators at our center over a period of more than 20 years, evaluating more than 7,300 patients who underwent radical prostatectomy. The aim of the study was to determine whether the systematic use of these risk calculators could help better identify patients who truly require lymph node removal, thereby avoiding more extensive surgerieswith a higher risk of complications.
The study results were very encouraging. With the introduction of these decision-making tools into clinical practice, the number of patients undergoing extensive pelvic lymph node dissection has gradually decreased, thereby allowing many men to avoid an additional surgical procedure andleading to a significant reduction in complications over time.
A very important point is that this reduction did not compromise the accuracy of tumor staging—that is, urologists’ ability to determine whether the disease had spread to the lymph nodes. In other words, patients who truly needed a lymphadenectomy continued to receive one.
These findings suggest that the use of risk calculators prior to surgery can provide urologists with valuable support in planning surgical procedures. These tools make it possible to better tailor treatment, avoiding more invasive procedures when the risk of lymph node metastasis is very low.
Barletta F, Scuderi S, Scilipoti P, Longoni M, Quarta L, Pellegrino A, Cannoletta D, Leni R, Zaurito P, Santangelo A, Gettman A, Viti A, Cosenza A, Brancaccio M, Stabile A, Montorsi F, Gandaglia G, Briganti A. Impact of Implementation of Risk Calculators for the Selection of Extended Pelvic Lymph Node Dissection Candidates: 20-year Experience from a Tertiary Referral Centre. Eur Urol Oncol. 2025 Dec;8(6):1583-1591. doi: 10.1016/j.euo.2025.08.006. Epub 2025 Oct 25. PMID: 41429699.
