Use of pelvic lymph node dissection among men undergoing radical prostatectomy in the US: Population-based analysis between 2010 and 2020.

PURPOSE: Pelvic lymph node dissection (PLND) is recommended for men undergoing radical prostatectomy (RP) with a > 2% probability of nodal metastasis based on preoperative nomograms. Data on the current use of PLND is outdated and limited to select centers. We assessed national trends in PLND, factors associated with PLND, and oncologic outcomes. METHODS: We identified men with localized prostate cancer (CaP) from the Surveillance, Epidemiology, and End Results (SEER) database who underwent RP from 2010 to 2020; PLND was confirmed via chart review. We examined temporal trends of PLND use; multivariable logistic regression identified factors associated with PLND. Multivariable competing risk-adjusted regression examined the association between PLND and prostate cancer-specific mortality (CaPSM). RESULTS: 148,460 men were included; 102,860 (69.3%) underwent PLND. Among PLND recipients, 58% of low-risk vs. 38% of high-risk patients had <6 nodes removed. PLND use increased over time across all risk groups (P < 0.01): from 35.4% to 49.3% (low-risk), 57.3% to 71.0% (favorable-intermediate), 71.4% to 84.2% (unfavorable-intermediate), and 86.1% to 91.5% (high-risk) between 2010 and 2020. Among patients with preoperative nomogram probability ≥2%, 78% underwent PLND compared to 39% with <2% probability (P < 0.001). The RP+PLND group did not have improved CaPSM as compared to the RP alone group when accounting for number of nodes removed (<6 nodes: HR 1.16, 95% CI 1.00-1.34; 6-12 nodes: HR 1.11, 95% CI 0.95-1.30; >12 nodes: HR 1.06, 95% CI 0.90-1.26). CONCLUSIONS: PLND use increased across all risk groups in the US from 2010 to 2020, suggesting overuse in low-risk and some intermediate-risk patients. Node yield was not associated with improved CaPSM.