Pelvic lymph node dissection (PLND) is performed frequently during radical prostatectomy to manage clinically localized prostate cancer, and has diagnostic and possible therapeutic benefits [1]. PLND provides more accurate staging information, which can guide adjuvant treatment decisions and confer important data for counseling on prognosis [2]. In addition, there may be a benefit in long-term oncologic outcomes when positive lymph nodes are resected [3], [4]. However, PLND adds operative time and possible surgical complications [5].

The extent of PLND is a subject of controversy. Some perform PLND limited to the obturator fossa, known as a limited PLND (lPLND). Meanwhile, others recommend PLND expanding to the internal, external, and common iliac templates, termed extended PLND (ePLND), to augment both the diagnostic and the therapeutic benefits of PLND. Retrospective studies have claimed a biochemical recurrence (BCR) benefit to ePLND, whereas randomized controlled trials (RCTs) have found lPLND and ePLND to be equivalent concerning BCR [4], [6], [7], [8]. Literature is further complicated by variations in definitions and templates employed for lPLND and ePLND.

Current American Urological Association (AUA) and European Urological Association guidelines suggest PLND in patients with intermediate- or high-risk disease [9], [10]. Additional nomogram tools, such as the Memorial Sloan Kettering and Briganti nomograms, have been suggested to identify ideal candidates for ePLND [11], [12].

In the setting of recent high-quality evidence, this systematic review aims to stratify and analyze available evidence on ePLND and its impact on BCR in patients with localized prostate cancer.