The newest procedure for lymph node sampling is called laparoscopic lymphadenectomy. A long telescope (laparoscope) is inserted through a tiny opening in the abdomen and is used to observe and guide the sampling of pelvic lymph nodes to see if they contain cancer. If the lymph nodes contain cancer, most surgeons would not perform a radical prostatectomy, because the side effects and disadvantages would outweigh the potential gains. The decision to use radiotherapy may also be influenced by the findings of this procedure. This sampling procedure also creates the option for other definitive surgical procedures that are easier on the patient and that may have fewer side effects.
The usefulness of laparoscopic pelvic lymph node sampling when done as a separate procedure is still being debated. Current recommendations include patients with clinically localized disease (Stage A or B) with a poorly differentiated tumor and a PSA of more than 30. Patients who are to have a radical prostatectomy can undergo laparoscopic lymph node sampling immediately before the perineal procedure. Many patients who are to have radiation therapy are also excellent candidates for laparoscopic lymph node sampling.
The removal of the prostate can be accomplished by an incision in the abdomen (the retropubic approach) or by an incision between the scrotum and anus (the perineal approach). The retropubic approach offers the ability to perform lymph node sampling and prostate removal in one step. Time spent in the operating room is usually less than for the perineal approach. Transfusions may be required and there is moderate pain from the abdominal incision. The perineal approach can be performed without lymph node sampling if the PSA and Gleason grade are low.
