There are two reasons to do pelvic lymph node dissection (PLND).
1) to help with staging (i.e. to detect metastasis) in which case the patient may decide whether or not he would like the surgeon to continue.
2) it is potentially therapeutic (i.e. if there is microscopic metastasis to a few nodes and they are all removed this may result in a cure, however the data on this is somewhat conflicted. Here are some papers showing potential benefit:
www.ncbi.nlm.nih.gov/pmc/articles/PMC2997840/www.ncbi.nlm.nih.gov/pmc/articles/PMC1950746/www.ncbi.nlm.nih.gov/pubmed/?term=15540734The reason not to do it is there is the potential for complications - primarily lympocele. Lympocele is usually minor and easily managed but rarely can cause significant chronic problems (e.g. lymphedema in the legs)
As with many aspects of surgery, I imagine the incidence of sequelae depend in great part on the skill of the surgeon and the post-op clinical protocol employed. The literature shows a wide variation in reported incidence of lymphoceles.
A study from University of Chicago (Orvieto et. al.) using post-op CT detected lymphoceles in 39 of 76 patients (51%) however only 6 of 76 (7.9%) were clinically symptomatic.
On the other hand, a paper from Hopkins (Allaf et. al.) reported lymphocele in only 3 out of 4000 patients (<0.1%)
Dr. Walsh addresses this issue in his book and explains that due to the potential benefit and low rate of complications (which are typically easily manageable when they due occur) it was made institutional policy at Johns Hopkins to perform lymph node dissection for all patients:
"one out of one hundred times, lymph nodes turn out to be positive in a patient in whom you would least expect it. Because we have found that these are also the exact patients who would benefit most from having these lymph nodes removed, we continue to do lymph node dissections in all patients. We are emboldened to do this because of the extremely low risk of complications associated with this, the ease with which a complete lymph node dissection can be performed in a short time, and the fact that more good can come from it than not."but Walsh also states that, given the declining rate of node positivity it is "understandable" for surgeons to omit dissection.
Another Doctor with whom I consulted, Arieh Shalhav (Chief of Urology at University of Chicago -- where the one paper above came from reporting 7.9% incidence of clinically symptomatic lympocele) was adamant that I should have lymph node dissection because he said he had been “burned too many times” by apparently low risk patients whose finally pathology turns out significantly worse and told me that while "annoying" lympocele is easily managed.
Dr. Burnett from Hopkins who did my surgery also stressed the potential benefit benefit and stated that
open RRP facilitates a better job of PLND.
My personal opinion is for a young healthy guy who is going to go through surgery the small incremental risk is negligible and well worth it for maximizing the possibility of cure.