NODE Study - Randomised Trial of Extended Pelvic Lymph Node Dissection In Patients Undergoing Robotic-Assisted Radical Prostatectomy For High-Risk Prostate Cancer

The intervention will be the performance of an extended pelvic lymph node dissection (ePLND). This procedure is performed during surgery for prostate cancer - specifically during a robotic radical prostatectomy, the current standard of care. Currently the procedure is performed variably by different urologists. Current guidelines recommend it being performed only in high risk patients. The procedure involves removal of many of the lymph nodes in the pelvis, and if cancer has spread to the lymph nodes, may help to remove all the cancer. To ensure consistency of surgery, surgeons will be required to take photos of the areas from which they have removed the lymph nodes to ensure enough has been taken out. The intervention will be performed by 3 experienced consultant urologists at the Chris O'Brien Lifehouse Hospital and Royal Prince Alfred Hospital. As a pilot, 20 patients will be recruited, this is to ensure that recruitment for a larger trial is possible and to ensure that adherence to the protocol by the surgeons is possible. The ePLND is expected to approximately 1 hour to the procedure, which currently takes 2-4 hours. Specific training is not required to perform the ePLND, though these surgeons have significant experience performing it. One of the researcher team will be present at all of the cases to monitor for protocol violations, after the pilot study recruitment is completed all patients will have a chart review, review of intraoperative images and initial data to assess for protocol violations.