Extended vs. No Pelvic Lymph Node Dissection During Radical Prostatectomy. DISSECTION 2.0.

This study is comparing two surgical approaches during prostate removal (radical prostatectomy) for high-risk prostate cancer: removing an extended number of lymph nodes in the pelvis versus removing no lymph nodes. The goal is to determine whether removing more lymph nodes improves cancer control and survival outcomes. **You may be eligible if...** - You are 18 years or older with a life expectancy of more than 15 years - You have high-risk prostate cancer confirmed by biopsy (grade group III–V, or grade group II with PSA above 20) - Your PSMA-PET scan shows no cancer spread to distant lymph nodes or other organs - Your surgical team has recommended a radical prostatectomy - You are fit enough for general anesthesia and surgery (ASA ≤ III, WHO performance 0–1) **You may NOT be eligible if...** - Your cancer has spread outside the prostate (distant metastasis on PSMA-PET) - Your tumor extends into nearby organs (cT4 on MRI) - You have had previous pelvic radiation or lymph node surgery - You have had prior prostate cancer treatment Talk to your doctor to see if this trial is right for you.