In the current era, pelvic lymph node dissection (PLND) is controversial, with no good quality randomised studies demonstrating oncological benefit. The latest European Association of Urology prostate cancer guidelines have downgraded their recommendation for lymph node dissection, saying only that if you are to perform PLND, then perform extended PLND. This study describes the Australian national surgical patterns of prostate cancer (PCa) care considering radical prostatectomy with or without pelvic lymphadenectomy.

Retrospective analysis of publicly accessible Medicare claims data was performed for the period 2000–2024 and included patients undergoing radical prostatectomy with or without pelvic lymphadenectomy.

Total prostatectomies performed increased from 2000-2009, with a slight decline from the period of 2009-2016. Following 2016, the trend of total prostatectomies continued to increase. Despite this, the ratio of concurrent pelvic lymphadenectomy to no pelvic lymphadenectomy fell from 4.47 in 2001, to a low of 0.27 in 2024 and the downward trend appears to be continuing. There were significant regional differences in different states of Australia, but the overall trend in all states was towards decreasing PLND.

An increasing proportion of cases omit concurrent pelvic lymphadenectomy which likely reflects the lack of high quality randomised evidence demonstrating the oncological benefits of pelvic lymph node dissection in during prostatectomy.