Not always. Your surgeon may remove pelvic lymph nodes during robotic prostatectomy if your cancer has a meaningful risk of spreading to them. This is called a pelvic lymph-node dissection (PLND) and can help detect cancer that scans may not have picked up.
If your lymph nodes are clear, this helps confirm your cancer stage. If cancer is found, your results may influence your follow-up and whether you need additional treatment, depending on the amount of cancer and your postoperative PSA.
Are Lymph Nodes Always Removed During Robotic Prostate Surgery?
No. You do not automatically need your pelvic lymph nodes removed during robotic prostate surgery. Your surgeon will assess your risk of lymph-node involvement using factors such as your PSA, Grade Group, cancer stage and MRI findings.
If your risk is high enough to justify lymph-node assessment, the nodes can usually be removed during the same robotic operation as your prostate. This means you generally do not need a separate operation just to remove the lymph nodes.
What Are Pelvic Lymph Nodes?
Your pelvic lymph nodes are small structures that form part of your lymphatic and immune systems. Because prostate cancer can sometimes spread from your prostate to these nearby nodes, they can provide important information about how far your cancer has progressed.
In prostate cancer staging, N0 means no regional lymph-node spread has been identified, while N1 means cancer has been found in nearby pelvic nodes. If your nodes contain cancer, it does not automatically mean you have distant metastatic disease, but it can affect your prognosis and further treatment.
Why Might Your Surgeon Remove Lymph Nodes?
Your surgeon may remove pelvic lymph nodes to get a more accurate picture of how far your prostate cancer has spread. Even when your scans look clear, very small cancer deposits can sometimes be too small to detect.
The removed nodes are examined by a pathologist to check for cancer cells, giving your team more reliable pathological staging. These results can help guide your follow-up and whether you may need additional treatment after surgery.
How Does Your Surgeon Decide Whether You Need Lymph-Node Dissection?
Your surgeon looks at several factors rather than relying on one test. Your PSA, Grade Group, clinical stage and MRI findings can all help estimate how likely your cancer is to have spread to your pelvic lymph nodes.
Your team may also use risk-prediction tools, or nomograms, to estimate your individual risk of lymph-node involvement. PSMA PET/CT findings can provide additional information, helping your surgeon decide whether the benefits of lymph-node dissection outweigh its potential risks for you.
Do Low-Risk Prostate Cancer Patients Usually Need Lymph Nodes Removed?
Usually not. If your prostate cancer has a very low risk of spreading to the lymph nodes, your surgeon may decide that a pelvic lymph-node dissection would add little benefit while exposing you to extra risks, such as a lymphocele.
Your PSA, Grade Group, clinical stage and imaging help your team assess this risk. If you have intermediate- or high-risk cancer, your surgeon will assess your estimated risk of lymph-node involvement using your PSA, Grade Group, stage, imaging and, where appropriate, a risk calculator. Being in a higher-risk group does not automatically mean that you need lymph-node dissection.
What Is an Extended Pelvic Lymph-Node Dissection?
An extended pelvic lymph-node dissection (ePLND) removes lymphatic tissue from several areas of your pelvis, including around the external iliac, obturator and internal iliac regions. It is more comprehensive than removing only a few suspicious-looking nodes.
Your lymph nodes may look normal during surgery but still contain microscopic cancer cells. An extended dissection can therefore provide more accurate staging, and the EAU recommends this approach when lymph-node dissection is performed during radical prostatectomy.
Can Robotic Surgery Remove the Lymph Nodes at the Same Time?
Yes. Your pelvic lymph nodes can usually be removed during the same robotic operation as your prostate, so you do not normally need a separate procedure or anaesthetic.
Your surgeon uses the robotic instruments to carefully remove the lymphatic tissue while working around nearby blood vessels, nerves and other structures. The tissue is then sent to a pathologist for examination, with your surgeon remaining in control throughout the procedure.
How Long Does Lymph-Node Removal Add to the Operation?
An extended pelvic lymph-node dissection usually makes your robotic prostate operation longer because your surgeon needs to carefully remove additional tissue from your pelvis. The exact extra time varies depending on your anatomy, the extent of the dissection and your surgeon’s technique.
A longer operation does not necessarily mean anything has gone wrong. If lymph-node removal is planned for you, your surgeon can explain how it may affect the operation, recovery and potential risks.
What Happens to the Removed Lymph Nodes?
After your lymph nodes are removed, they are sent to a pathology laboratory with your prostate tissue. A pathologist examines them under a microscope to check whether prostate cancer cells are present and records how many nodes were removed and how many contained cancer.
If no cancer is found, your result may be recorded as pN0; if cancer is found in regional nodes, it may be recorded as pN1. Your team will consider this alongside your Grade Group, tumour stage, surgical margins and postoperative PSA when deciding what happens next.
What Lymph-Node Results Can Mean
| Result | What it means | What may happen next |
| pN0 | No prostate cancer was found in the lymph nodes that were removed and examined | Your team will consider this alongside your PSA, tumour stage, Grade Group and surgical margins when planning follow-up |
| pN1 | Prostate cancer was found in one or more regional pelvic lymph nodes | Your team may discuss ADT, ADT combined with radiotherapy or, in selected patients with limited nodal disease and an undetectable PSA, careful observation |
| Small-volume nodal involvement | Only a limited amount of cancer is found in the removed lymph nodes | Management may depend heavily on your postoperative PSA and other pathology findings |
| More extensive nodal involvement | Cancer is found in several nodes or there is a greater burden of nodal disease | Additional treatment may be more strongly considered depending on your full pathology and PSA results |
What Does a Negative Lymph-Node Result Mean?
A negative result means your pathologist did not find prostate cancer in the lymph nodes that were removed and examined. This is reassuring because there is no pathological evidence of cancer in those regional nodes.
However, a negative result cannot prove that no microscopic cancer exists elsewhere in your body. Your overall outlook also depends on your Grade Group, tumour stage, surgical margins and other pathology findings, while your PSA after surgery remains important for monitoring your cancer control.
What Does It Mean If Cancer Is Found in a Lymph Node?
If your pathologist finds prostate cancer in one or more pelvic lymph nodes, your pathological stage is classified as pN1. This means cancer has reached the regional lymphatic system, but it does not automatically mean you have widespread metastatic disease.
The amount of cancer in your lymph nodes matters, as does your final prostate pathology and postoperative PSA. Depending on your nodal burden, other pathology findings and postoperative PSA, your team may discuss ADT, ADT combined with radiotherapy or careful observation in selected cases.
UK Guidance Note
UK treatment decisions after prostatectomy should be made using the complete pathology report and postoperative PSA rather than the lymph-node result alone. NICE recognises radical prostatectomy as a treatment option for appropriate higher-risk prostate cancer, but its current prostate cancer guideline does not provide the same level of detailed modern pN1 postoperative stratification as the current EAU guideline. NICE NG131 was reviewed in 2025 and the localised and locally advanced prostate cancer section is being updated.
For this reason, patients with positive lymph nodes should be discussed within a specialist prostate cancer multidisciplinary team. Current European guidance allows ADT, ADT combined with radiotherapy or observation after ePLND in selected men with no more than two positive nodes and an undetectable postoperative PSA.
Will Positive Lymph Nodes Mean You Need Hormone Treatment?
Not necessarily. If your lymph nodes contain cancer, your team may consider hormone treatment (ADT), but the decision depends on your overall risk and postoperative results.
Your PSA after surgery is particularly important. If your PSA becomes undetectable and only one or two nodes contain cancer, observation may be an option in selected cases. Depending on your overall pathology and recurrence risk, your team may instead recommend ADT alone or ADT combined with radiotherapy.
Can Positive Lymph Nodes Lead to Radiotherapy After Surgery?
Yes. If your lymph nodes contain prostate cancer, your team may consider radiotherapy after surgery, particularly when other features suggest a higher risk of recurrence.
Your doctors will look at the number of affected nodes, the amount of cancer within them, your final prostate pathology and your PSA after surgery. For pN1 disease, postoperative radiotherapy is generally considered as part of a treatment plan that also includes ADT rather than as an isolated decision. Needing further treatment does not automatically mean your surgery failed; for some higher-risk cancers, combining treatments is part of the planned approach.
Does Removing Lymph Nodes Improve Prostate Cancer Survival?
Not necessarily. Pelvic lymph-node dissection can give your team more accurate information about whether cancer has reached your lymph nodes, but it has not been conclusively shown to improve survival by itself.
Current evidence has not established a consistent biochemical-recurrence or survival benefit from performing a more extensive lymph-node dissection. A recent follow-up of a randomised trial reported fewer distant metastases after extended dissection, but biochemical recurrence remained similar between the groups. The clearest established role of ePLND therefore remains accurate pathological staging.
Evidence Note
Extended pelvic lymph-node dissection remains the most accurate surgical method for identifying regional lymph-node metastases that may be missed by imaging. Current European guidance therefore recommends an extended dissection when lymph-node surgery is performed during radical prostatectomy.
Randomised evidence has not shown a clear improvement in biochemical recurrence or survival from extended compared with limited dissection. A 2025 follow-up of a randomised trial did report fewer distant metastases after extended dissection, although biochemical recurrence and local nodal recurrence remained similar. The main established role of ePLND therefore remains accurate staging and helping guide further treatment.
Why Can PSMA PET/CT Not Always Replace Lymph-Node Dissection?
PSMA PET/CT has improved prostate cancer staging, but it cannot detect every tiny cancer deposit. Very small areas of cancer in your lymph nodes may remain below the scan’s resolution, so a negative result does not always mean your nodes are completely clear.
If your risk of lymph-node involvement is high enough, your surgeon may still recommend lymph-node dissection to obtain more accurate pathological staging. Your PSMA PET/CT, risk factors and treatment plan will all be considered together.
What Are the Risks of Pelvic Lymph-Node Dissection?
Pelvic lymph-node dissection adds some risks to your prostate surgery, including bleeding, blood clots, injury to nearby structures and lymphatic swelling. One of the more recognised complications is a lymphocele, where lymphatic fluid collects in your pelvis.
The risk of complications can increase when a more extensive lymph-node dissection is performed. Your own risk will depend on factors such as your health, anatomy and the extent of your surgery, so your surgeon should explain whether the potential staging benefit makes lymph-node removal worthwhile for you.
What Is a Lymphocele?
A lymphocele is a collection of lymphatic fluid that can develop in your pelvis after lymph nodes and their small lymphatic vessels are removed. Small lymphoceles often cause no symptoms and may only be discovered during an imaging scan.
Larger lymphoceles can cause pelvic discomfort, leg swelling, pressure or infection and may sometimes need drainage. Symptomatic lymphocele rates vary between centres, and the risk generally increases with more extensive lymph-node dissection.
Does Lymph-Node Removal Change Your Recovery?
Your recovery may be broadly similar to robotic prostate surgery without lymph-node removal, although the operation is slightly more extensive. Your team may monitor you more closely for certain complications.
- Pelvic swelling: Fluid can occasionally collect in the pelvis after lymph-node removal.
- Leg swelling: You may notice swelling if lymphatic drainage is affected.
- Blood-clot prevention: Early movement and other preventive measures remain important during recovery.
- Monitoring symptoms: Fever, increasing discomfort or unusual swelling should be reported to your clinical team.
Most people follow a similar general recovery pathway after surgery. Your surgeon can explain whether lymph-node removal is likely to change your individual recovery.
What Should You Ask Before Your Robotic Prostatectomy?
Before surgery, ask your surgeon whether you need pelvic lymph-node removal and why it is recommended for your cancer. You can also ask how your PSA, Grade Group, MRI, clinical stage and PSMA PET/CT findings affect this decision.
If lymph-node dissection is planned, ask whether you will have an extended PLND and what additional risks, such as lymphocele, you should know about. It is also worth asking what further treatment might be considered if cancer is found in the nodes, including monitoring, radiotherapy or hormone treatment.
Myth vs Fact
| Myth | Fact |
| Everyone having robotic prostate surgery needs their lymph nodes removed. | No. The decision depends on your estimated risk of lymph-node involvement. |
| A clear PSMA PET/CT proves your lymph nodes are cancer-free. | No. Very small nodal metastases can remain below the scan’s detection limit. |
| Removing more lymph nodes is proven to improve survival. | No. ePLND improves pathological staging, but a consistent survival benefit from the procedure itself has not been established. |
| A positive lymph node means you have widespread metastatic cancer. | No. pN1 means cancer has reached regional pelvic lymph nodes; distant metastatic disease is classified separately. |
| Everyone with positive lymph nodes needs the same treatment afterwards. | No. Further management depends on nodal burden, other pathology findings and postoperative PSA. |
Key Takeaways
- Pelvic lymph nodes are not automatically removed during every robotic prostatectomy.
- If lymph-node dissection is needed, current European guidance recommends an extended pelvic lymph-node dissection for more accurate staging.
- A negative PSMA PET/CT cannot completely exclude microscopic lymph-node cancer.
- The main proven benefit of lymph-node dissection is accurate pathological staging; a clear survival benefit from removing more lymph nodes has not been established.
- If cancer is found in the nodes, further treatment depends on the number of affected nodes, final pathology and postoperative PSA, and may involve monitoring, ADT, radiotherapy or a combination.
Frequently Asked Questions
1. Are lymph nodes always removed during robotic prostate surgery?
No, you do not automatically need your pelvic lymph nodes removed. Your surgeon will assess your risk of lymph-node involvement based on factors such as your PSA, Grade Group, cancer stage and imaging.
2. Why might your surgeon remove lymph nodes during robotic prostate surgery?
Lymph-node removal can help determine whether prostate cancer has spread beyond your prostate. This provides more accurate staging and can help your team decide whether you may need further treatment.
3. Can lymph nodes be removed during the same robotic operation?
Yes, pelvic lymph nodes can usually be removed during the same operation as your robotic prostatectomy. You generally do not need a separate procedure or anaesthetic for the lymph-node dissection.
4. What is an extended pelvic lymph-node dissection?
An extended pelvic lymph-node dissection removes lymphatic tissue from several areas of your pelvis. It provides more comprehensive pathological staging than removing only a small number of nearby nodes.
5. What does a negative lymph-node result mean?
A negative result means no cancer was found in the lymph nodes that were removed and examined. This is reassuring, although your overall prognosis also depends on your PSA, Grade Group, tumour stage and other pathology results.
6. What does it mean if cancer is found in your lymph nodes?
Cancer found in nearby pelvic lymph nodes means your cancer is classified as pN1. It does not automatically mean that you have distant metastatic cancer, but you may need additional treatment or closer monitoring.
7. Will positive lymph nodes mean you need hormone treatment?
Not necessarily. Your team will consider the number of affected nodes, your other pathology findings and your postoperative PSA. Depending on these results, options may include observation in selected cases, ADT alone or ADT combined with radiotherapy.
8. Can you need radiotherapy if cancer is found in your lymph nodes?
Yes. If cancer is found in your pelvic lymph nodes, postoperative radiotherapy may be considered alongside ADT, particularly when your pathology suggests a higher risk of recurrence.
9. What are the risks of pelvic lymph-node removal?
Lymph-node dissection can increase the risk of complications such as bleeding, blood clots, injury to nearby structures and lymphoceles. Your individual risk depends on your health, anatomy and how extensive the surgery needs to be.
10. Does removing lymph nodes improve prostate cancer survival?
Not necessarily. Lymph-node removal provides valuable information about whether cancer has spread to the regional nodes, but removing more lymph nodes during prostatectomy has not been conclusively shown to improve survival by itself.
Final Thoughts: Understanding Lymph-Node Removal During Robotic Prostate Surgery
Lymph-node removal is not necessary for everyone having robotic prostate surgery. If your cancer has a higher risk of spreading to your pelvic lymph nodes, removing and examining them can provide important information about your cancer stage and help your team decide whether you may benefit from further treatment.
If you are considering robotic prostate surgery in London, you may wish to ask your surgeon why lymph-node removal is recommended for you and what the results could mean for your treatment. Understanding the potential benefits and risks can help you make a more informed decision about your prostate cancer care.
References:
- European Association of Urology (2026) EAU Guidelines on Prostate Cancer. EAU Guidelines Office, Arnhem, The Netherlands. Available at: https://uroweb.org/guidelines/prostate-cancer
- National Institute for Health and Care Excellence (2019, updated 2021) Prostate cancer: diagnosis and management. NICE guideline NG131. Available at: https://www.nice.org.uk/guidance/ng131
- Hope, T.A. et al. (2021) ‘Diagnostic accuracy of 68Ga-PSMA-11 PET for pelvic nodal metastasis detection prior to radical prostatectomy and pelvic lymph node dissection: a multicenter prospective phase 3 imaging trial’, JAMA Oncology, 7(11), pp. 1635–1642. Available at: https://pubmed.ncbi.nlm.nih.gov/34529005/
- Touijer, K.A. et al. (2025) ‘Pelvic lymph node dissection in prostate cancer: update from a randomized clinical trial of limited versus extended dissection’, European Urology, 87(2), pp. 253–260. Available at: https://pubmed.ncbi.nlm.nih.gov/39472200/
- Neuberger, M. et al. (2024) ‘Peritoneal flap for lymphocele prophylaxis following robotic-assisted radical prostatectomy with lymph node dissection: the randomised controlled phase 3 PELYCAN trial’, European Urology Oncology, 7(1), pp. 53–62. Available at: https://pubmed.ncbi.nlm.nih.gov/37543465/