Validating a New Tool for One-Sided Lymph Node Surgery in Prostate Cancer

What is it about?

This study aimed to evaluate the rationale of unilateral extended pelvic lymph node dissection (ePLND) during radical prostatectomy by externally validating a nomogram for unilateral ePLND (unilat-NG) and comparing it to the Briganti 2019 nomogram. The research involved 406 patients who underwent magnetic resonance imaging-fusion biopsy and radical prostatectomy with bilateral ePLND from a high-volume tertiary care center. The primary endpoint was the detection rate of lymph node invasion (LNI) contralateral to the prostatic lobe with adverse cancer characteristics. The unilat-NG nomogram's performance was measured using the area under the curve (AUC) with cut-offs of 1%, 2%, and 2.5%, yielding AUC values of 0.58, 0.67, and 0.69, respectively, while the Briganti 2019 nomogram achieved an AUC of 0.72 with a 7% cut-off. This study concluded that the Briganti 2019 nomogram outperformed the unilat-NG in predicting contralateral LNI. However, a significant proportion of patients undergoing unilateral ePLND might be misclassified, supporting the continuation of bilateral ePLND as the standard of care.

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Why is it important?

This study investigates the effectiveness and practicality of using unilateral extended pelvic lymph node dissection (ePLND) during radical prostatectomy (RP) compared to the traditional bilateral approach. Given the increased morbidity, cost, and hospital stay associated with bilateral ePLND, exploring less invasive alternatives while maintaining diagnostic accuracy is important. This study examines the performance of a newly developed nomogram (unilat-NG) for predicting lymph node invasion (LNI) against the established Briganti 2019 nomogram. Key Takeaways: 1. This study demonstrates that the Briganti 2019 nomogram outperforms the newly developed unilat-NG in predicting lymph node invasion contralateral to the dominant lobe during radical prostatectomy. 2. Findings reveal that using the unilat-NG with a 2.5% cut-off could allow for the omission of contralateral ePLND in approximately 74.6% of patients, but also risk misclassifying a small percentage of patients with pN0 disease. 3. The research highlights that despite the potential benefits of unilateral ePLND, a significant proportion of patients could be inaccurately staged, underscoring the continued necessity of bilateral ePLND as the standard surgical staging method when pelvic lymph node dissection is indicated.