Organ-confined prostate cancer or lymph node involvement?

In order to choose the best form of treatment for you, it is of great importance to know whether tumor metastases are present in the lymph nodes. If this is the case, your disease is no longer in an early stage and can only be completely cured in rare cases. Unfortunately, computed tomography (CT) and magnetic resonance imaging (MRI) are of very limited value in detecting microscopic involvement of the lymph nodes.

If there is an increased risk of lymph node involvement - which can nowadays be calculated in advance - lymph node tissue can therefore be removed and examined by means of a small operation. This risk of lymph node involvement depends on certain criteria (tumor stage, PSA value and Gleason score of the tumor). The operation can be performed through a small lower abdominal incision or laparoscopically and involves a hospital stay of a few days. The side effects are very low. Lymph node tissue is taken from precisely defined locations and examined by a pathologist under the microscope.

Thanks to modern forms of radiation therapy, however, the radiation field can now be defined so precisely and limited to the lymphatic drainage pathways that the possible side effects have been extremely reduced. Therefore, in patients with a high risk profile, the tissue outside the prostate gland tends to be irradiated as well for safety reasons, and the intervention has generally become unnecessary.

Bei Patienten mit einem frühen Tumorstadium (< cT2b), einem PSA-Wert < 10 ng/ml sowie einem Gleason Score < 6 kann ohnehin auf eine Lymphknotenentfernung verzichtet werden.

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