A standard staging pelvic lymphadenectomy (dissection of the pelvic lymph nodes) generally is performed just before a radical prostatectomy. (This varies among doctors and hospitals; some doctors base this decision on the Gleason score.) If the lymph nodes are entirely free of cancer or—in some cases, almost entirely free—the surgeon proceeds with the operation to remove the prostate.
We need to clarify here: When prostate cancer has spread to the lymph nodes, it cannot be cured. However, if the cancer fits certain conditions—if cancer in the lymph nodes is microscopic and the Gleason score is lower than 8—there is still a chance that surgery will help control the disease locally. This is important for younger men who can expect to live a long time. In this case, for men younger than 70, many surgeons will still perform a radical prostatectomy, because there is a good chance that these men may live for many years before the cancer reappears elsewhere. Also, surgery in these men reduces the risk of other cancer-related problems, such as urinary obstruction or bleeding, developing later.
If disease that was thought to be localized turns out to be widespread, however, the operation generally does not continue; it wouldn’t do any good. (Imagine what a blow this is to the patient; worse, even though he didn’t have the full operation, he still had an incision and his lymph nodes removed; he’ll have to be in the hospital for nearly a week, just to recover from this. This is why staging candidates carefully before surgery is so important—because it could help a man avoid such an ordeal.)
The laparoscopic pelvic lymphadenectomy has a reduced hospital stay (see above). But if the lymph nodes are negative, giving the green light to a radical retropubic or perineal prostatectomy, many men then go ahead and have that surgery.
The goal behind the “Minilap” is to provide the best of both worlds. It begins with an incision slightly larger than in the laparoscopic procedure. If there’s cancer in the lymph nodes, the incision is closed. But if the lymph nodes are cancer-free, this incision is lengthened and the radical retropubic prostatectomy is performed under the same anesthetic.
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