The prognostic value of lymph node staging with prostate‐specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) and extended pelvic lymph node dissection in node‐positive patients with prostate cancer

Abstract

Objectives To investigate whether patients with suspected pelvic lymph node metastases (molecular imaging [mi] N1) on staging prostate‐specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) had a different oncological outcome compared to those in whom the PSMA PET/CT did not reveal any pelvic lymph node metastases (miN0). Patients and Methods All patients with pelvic lymph node metastatic (pN1) disease after robot‐assisted radical prostatectomy (RARP) and extended pelvic lymph node dissection (ePLND) between January 2017 and December 2020 were included. To assess predictors of biochemical progression of disease after RARP, a multivariable Cox regression analysis was performed, including number of tumour‐positive lymph nodes, diameter of the largest nodal metastasis, and extranodal extension. Results In total, 145 patients were diagnosed with pN1 disease after ePLND. The median biochemical progression‐free survival in patients with miN0 on PSMA PET/CT was 13.7 months, compared to 7.9 months in patients with miN1 disease (P = 0.006). On multivariable Cox regression analysis, both number of tumour‐positive lymph nodes (>2 vs 1–2: hazard ratio [HR] 1.97; P = 0.005) and diameter of the largest nodal metastasis (HR 1.12; P < 0.001) were significant independent predictors of biochemical progression of disease. Conclusion Patients in whom pelvic lymph node metastases were suspected on preoperative PSMA imaging (miN1), patients diagnosed with >2 tumour‐positive lymph nodes, and patients with a larger diameter of the largest nodal metastasis had a significantly increased risk of biochemical disease progression after surgery.

18F-JK-PSMA-7 PET/CT for staging intermediate- or high-risk prostate cancer patients before radical prostatectomy: a pilot study

“…A recent paper showed that the patients in whom pelvic lymph node metastases were suspected on preoperative PSMA imaging had a significantly increased risk of biochemical disease progression after surgery (Meijer et al 2022 ).…”

Efficacy and Safety of Brazilian Green Propolis in Biochemically Recurrent Prostate Cancer after Radical Prostatectomy: A Single-Arm Phase II Study

“…While overall cancer control rates are mostly acceptable for clinically localized PCa after RP, and improved outcome of RP using novel imaging tools such as prostate specific membrane antigen (PSMA) positron emission tomography (PET)/CT and indocyanine green (ICG) guidance might be expected, 20-30% of patients experience a recurrence that initially presents as elevated serum PSA without clinical or radiographic metastases [2,[27][28][29]. However, not all patients with BCR develop disease progression and metastases, and the clinical course of the patients is highly variable.…”

Is solo indocyanine green‐guided lymphadenectomy a feasible alternative to standard pelvic lymph node dissection?

“…Moreover, as previously discussed, the count of positive nodes remains a pivotal prognostic indicator [4], potentially steering us toward contemplating adjuvant interventions for these patients. It is evident that having more than two positive nodes will substantially impact the risk of biochemical recurrence.…”

“…Unlike the ICG technique, which essentially provides a lymphography of the pelvic template, SPECT‐CT delivers functional imaging that conveys an authentic depiction of the sentinel node. Moreover, as previously discussed, the count of positive nodes remains a pivotal prognostic indicator [4], potentially steering us toward contemplating adjuvant interventions for these patients. It is evident that having more than two positive nodes will substantially impact the risk of biochemical recurrence.…”