Node-Positive Prostate Cancer Patients and Prognosis: The Role of PSMA PET/CT and Lymph Node Surgery

What is it about?

This study investigated the oncological outcomes of patients with suspected pelvic lymph node metastases (miN1) on staging prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) compared to those in whom the PSMA PET/CT did not reveal any metastases (miN0). A total of 145 patients who underwent robot-assisted radical prostatectomy (RARP) and extended pelvic lymph node dissection (ePLND) between January 2017 and December 2020 were included. The median biochemical progression-free survival in patients with miN1 disease was 7.9 months, compared to 13.7 months in patients with miN0 disease (P = 0.006). On multivariable Cox regression analysis, both number of tumor-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.

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Why is it important?

This research is important because it highlights the significance of preoperative PSMA PET/CT imaging in identifying patients with pelvic lymph node metastases (pN1) who are at a higher risk of biochemical disease progression after surgery. By evaluating the oncological outcomes of patients with and without suspected pelvic lymph node metastases on PSMA PET/CT, the study provides valuable insights into the prognostic factors for biochemical progression-free survival (bPFS) after robot-assisted radical prostatectomy (RARP) and extended pelvic lymph node dissection (ePLND). Key Takeaways: 1. Patients with suspected pelvic lymph node metastases (miN1) on PSMA PET/CT had a significantly lower bPFS compared to those without suspected lymph node metastases (miN0). 2. The presence of >2 positive lymph nodes and a larger diameter of the largest nodal metastasis were significant independent predictors of biochemical disease progression after surgery. 3. Preoperative PSMA PET/CT imaging is useful in selecting patients who may benefit from (neo)adjuvant treatment, potentially improving clinical outcomes.