The Prognostic Value of Lymph-Node Staging with PSMA PET/CT and ePLND in Node-Positive PCa Patients.

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).

All patients with pelvic lymph node metastatic (pN1)-disease after 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 the number of tumor-positive lymph-nodes, the diameter of the largest nodal metastasis, and extra-nodal extension.

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 the number of tumor-positive lymph-nodes (>2 versus 1-2; HR 1.97; p=0.005) and the diameter of the largest nodal metastasis (HR 1.12; p<0.001) were significant independent predictors of biochemical progression of disease.

Patients in whom pelvic lymph-node metastases were suspected on preoperative PSMA imaging (miN1), patients diagnosed with >2 tumor-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.

BJU international. 2022 Sep 07 [Epub ahead of print]

Dennie Meijer, Rosemarijn H Ettema, Pim J van Leeuwen, Theo H van der Kwast, Henk G van der Poel, Maarten L Donswijk, Daniela E Oprea-Lager, Elise M Bekers, André N Vis

Department of Urology, Amsterdam University Medical Center, VU University, Prostate Cancer Network Netherlands, Amsterdam, The Netherlands., Department of Urology, The Netherlands Cancer Institute, Prostate Cancer Network Netherlands, Amsterdam, The Netherlands., Department of Pathology, University Health Network, Toronto, Canada., Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Radiology & Nuclear Medicine, Amsterdam University Medical Center, VU University, Cancer Center Amsterdam, Amsterdam, The Netherlands., Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.