**5. Pelvic lymph node dissection**

For patients with low risk disease, PLND is not necessary and is not recommended, because the chance of metastasis is low.

For patients with high and intermediate risk disease, extended PLND at least for external iliac, obturator and hypogastric lymph nodes should be performed during radical prostatectomy. Removing at least 10 lymph nodes is recommended to detect LNI. (52)

Prostate cancer lymphatic spread ascends from the pelvis up to the retroperitoneum invariably through common iliac lymph nodes. PC lymphatic spread can be divided in two main levels: pelvic and common iliac plus retroperitoneal lymph nodes. (53)

So the technique try to remove all lymphatic tissue between the external iliac vein and hypogastric vein above and below the obturator nerve, including the hypogastric and obturator lymph nodes.

Therefore may assert that an eLND should be performed in all high-risk cases, as the estimated risk for positive lymph nodes will be in the range 15-40%. (10)

However, despite the above, some authors like Bubley are not so categorical in affirming this.

Although it is generally accepted that eLND provides important information for prognosis (number of nodes involved, tumour volume within the lymph node, capsular perforation of the node) that cannot be matched by any other current procedure, consensus has not been reached as to when eLND is indicated and to what extent it should be performed. When making such decisions, many physicians rely on nomograms based on pre-operative biochemical markers and biopsies. (54)
