Personalized Indocyanine-Guided Lymphadenectomy for Prostate Cancer: A Randomized Clinical Trial

What is it about?

The study compares the safety and efficacy of personalized indocyanine green (ICG)-guided pelvic lymph node dissection (PLND) against extended PLND (ePLND) during radical prostatectomy (RP) in patients with intermediate- or high-risk prostate cancer. A total of 108 patients were enrolled in the randomized clinical trial, with a median follow-up of 16 months. The postoperative complication rate was significantly higher in the ePLND group (70%) compared to the ICG-PLND group (32%) (P < 0.001). The rate of undetectable PSA at 12 months was 83% in the ICG-PLND vs 76% in the ePLND group, which was not statistically significant. There were no statistically significant differences in biochemical recurrence-free survival between the groups at the end of the analysis. The study suggests that ICG-guided PLND is a promising technique to stage patients with intermediate- and high-risk PCa properly, with a lower complication rate than ePLND with similar oncological outcomes at short-term follow-up.

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Why is it important?

This research is important as it provides the first randomized clinical trial (RCT) evaluation of the safety and efficacy of a personalized indocyanine green (ICG)-guided pelvic lymph node dissection (PLND) against an extended PLND (ePLND) during radical prostatectomy (RP) for intermediate- or high-risk prostate cancer (PCa). This study shows promising results in terms of lower complication rates with similar oncological outcomes at short-term follow-up, suggesting a potential alternative to conventional ePLND. Key Takeaways: 1. The study enrolled 108 patients, with a median follow-up of 16 months, comparing personalized ICG-guided PLND against extended PLND (ePLND) during radical prostatectomy (RP). 2. The postoperative complication rate was significantly higher in the ePLND group (70%) compared to the ICG-guided PLND group (32%). 3. The rate of major complications (Clavien-Dindo Grade III-IV) was not statistically significant between the two groups. 4. The detection rate of pN1 was higher in the ICG-guided PLND group (28%) compared to the ePLND group (22%), but the difference was not statistically significant. 5. The rate of undetectable prostate-specific antigen (PSA) at 12 months was 83% in the ICG-guided PLND group vs 76% in the ePLND group, with no statistically significant difference between the groups. 6. The study suggests that ICG-guided PLND could be an alternative to conventional ePLND, with lower complication rates and similar oncological outcomes at short-term follow-up.