Episode # 313 • 30 Jun 2026
Approaches to Pelvic Lymph Node Dissection in Contemporary Prostate Cancer Surgery
Is pelvic lymph node dissection still necessary in the era of PSMA PET imaging? In this episode of BackTable Urology, Dr. Ruchi Talwar interviews Dr. Kirsten Greene about how advanced imaging is influencing decisions for radical prostatectomy. They examine the strengths and limits of PSMA PET, the risks and benefits of PLND, and why careful, evidence-based decision-making remains essential.
This podcast was developed in collaboration with Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU).
Timestamps
00:00 - Introduction
03:12 - Risk Calculators and Consent
04:39 - Nomograms vs. Complications
09:57 - Endpoints That Matter
11:38 - PSMA PET Strengths and Limits
13:51 - Negative PET Decision-Making
15:08 - Positive PET and Multimodal Care
18:02 - Fluorescence Guided Surgery
19:10 - Counseling on Complications
22:27 - Preventing Lymphocele
24:56 - How Lahey Wrap Works
26:45 - Future Mapping and Therapy
28:47 - Research Gaps and Dogma
31:07 - Key Pearls and Wrap Up
Resources
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More about this episode
Dr. Greene explains her approach using MSK and Briganti nomograms alongside PSMA PET, noting that PET scans may miss small nodal disease and quality varies between centers. She emphasizes PLND as a staging tool rather than a curative procedure, outlining potential complications like lymphocele, lymphedema, vascular and ureteral injury, and neuropraxia. The episode highlights her shared decision-making process, surgical techniques for limiting risk, and the importance of multimodal planning, especially for PET-positive nodal disease. Dr. Greene also shares practical tips for lymphocele prevention, including the use of metal clips and the Lahey wrap.
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