Clinical Summary:

• Design/Population: In this randomized, phase 3 trial, researchers compared extended and limited pelvic lymph node dissection in patients with localized intermediate- or high-risk prostate cancer undergoing radical prostatectomy. 
• Key Outcomes: Extended dissection did not improve survival outcomes in the overall population but was associated with improved biochemical recurrence-free survival in patients with high-grade disease. 
• Clinical Relevance: Routine extended pelvic lymph node dissection may not provide broad oncologic benefit but may be clinically useful in selected patients with high-grade prostate cancer, supporting a risk-adapted surgical approach rather than universal extended dissection.

Long-term results from a phase 3 trial demonstrated that extended pelvic lymph node dissection did not improve survival outcomes compared with limited pelvic lymph node dissection among patients with intermediate- or high-risk prostate cancer undergoing radical prostatectomy. 

These results were presented by Matheus Ruggeri, MD, Universidade de São Paulo, Brazil, at the 2026 American Urological Association (AUA) Annual Meeting in Washington, District of Columbia.

In this study, 300 patients without evidence of metastases or prior treatment were randomized 1: 1 to undergo either extended or limited pelvic lymph node dissection. Extended dissection included bilateral obturator, external, internal, common iliac, and presacral nodes and limited dissection included only bilateral obturator nodes. The primary end point was biochemical recurrence-free survival (RFS). Key secondary end points included  metastasis-free survival, cancer-specific survival, and overall survival (OS).

At a median follow-up of 112 months, biochemical recurrence rates were similar between treatment arms (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.66 to 1.31; P = .681). No significant differences were observed in metastasis-free survival (HR, 0.93; 95% CI, 0.7 to 2.89; P = .32), cancer-specific survival (HR, 0.97; 95% CI, 0.6 to 1.57; P = .892), and OS (HR, 1.01; 95% CI, 0.29 to 3.49; P = .988).

Among patients with preoperative ISUP grade 3 to 5 disease, extended dissection maintained improved biochemical RFS (HR, 1.92; 95% CI, 1.04 to 3.57; P = .034) and significantly prolonged metastasis-free survival MFS (HR, 5.12; 95% CI, 1.12 to 23.42; P = .035).

Results “showed no [OS] or oncologic superiority of [extended pelvic lymph node dissection] over [limited pelvic lymph node dissection],” concluded Dr Ruggeri. “In patients with high-grade tumors, extended dissection sustained long-term benefits… suggesting a potential role for [extended pelvic lymph node dissection] in this specific subgroup.”

Source:

Ruggeri MT, Pontes J, Gugliemelmetti GB, et al. Long-term oncological outcomes of extended versus limited pelvic lymph node dissection during radical prostatectomy for intermediate- and high-risk prostate cancer: Phase 3 randomized clinical trial. J Urol. Published online: May 1, 2026. doi:10.1097/01.JU.0001192572.07890.f8.02