Extended pelvic lymph node dissection (ePLND) is recommended in selected radical prostatectomy (RP) prostate cancer (PCa) patients for staging purposes. We aim to externally validate available tools to predict lymph node invasion (LNI) in men with negative preoperative prostate-specific membrane antigen positron emission tomography (miN0).
Overall, 282 intermediate- to high-risk PCa patients with miN0 disease undergoing RP and ePLND at ten centers between 2016 and 2023 were identified. The Memorial Sloan Kettering Cancer Center (MSKCC); Amsterdam-Brisbane-Sydney; and Briganti 2017, 2019, and 2023 tools predicting LNI were validated externally using calibration plots, C-indexes, and decision-curve analyses to assess calibration, discrimination, and net benefit.
Overall, 36 (13%) patients had LNI. The C-indexes of the MSKCC, Briganti 2017, Briganti 2019, Amsterdam-Brisbane-Sydney, and Briganti 2023 nomograms were 64%, 69%, 72%, 64%, and 77%, respectively. The Briganti 2023 nomogram exhibited higher net benefit than the other available nomograms, and the use of a 5% cutoff would have spared 47% ePLND procedures (vs 14% and 4.3% for the Briganti 2019 and Amsterdam-Brisbane-Sydney nomograms, respectively) at the cost of missing only five (3.8%) LNI cases. Heterogeneity in patient selection and imaging protocols represents the main limitations.
The Briganti 2023 nomogram outperformed other available tools in predicting LNI in men with miN0 PCa. The use of this tool resulted in a considerable number of unnecessary ePLND procedures spared and optimization of ePLND recommendations in a contemporary clinical setting.
European urology oncology. 2025 Jan 30 [Epub ahead of print]
Giorgio Gandaglia, Francesco Barletta, Simone Scuderi, Pietro Scilipoti, Pawel Rajwa, Nicolai A Huebner, Juan Gomez Rivas, Laura Ibanez, Timo F W Soeterik, Lorenzo Bianchi, Agostino Mattei, Claudia Kesch, Christopher Darr, Hongqian Guo, Junlong Zhuang, Fabio Zattoni, Wolfgang P Fendler, Giancarlo Marra, Armando Stabile, Daniele Robesti, Daniele Amparore, Steven Joniau, Riccardo Schiavina, Jesus Moreno Sierra, Francesco Porpiglia, Maria Picchio, Arturo Chiti, Alexandre Mottrie, Roderick C N van den Bergh, Shahrokh F Shariat, Francesco Montorsi, Alberto Briganti
Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy., Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address: ., Department of Urology, Medical University of Vienna, Vienna, Austria; Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland., Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Urology, Hospital Clinico San Carlos, Madrid, Spain., Department of Urology, St Antonius Hospital, Utrecht, The Netherlands., Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy., Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland., Department of Urology, West German Cancer Center, University of Duisburg, Essen, Germany; German Cancer Consortium, University Hospital Essen, Essen, Germany., Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Jiangsu, China., Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, Padua, Italy; Department of Medicine - DIMED, University of Padua, Padua, Italy., Department of Nuclear Medicine, University of Duisburg-Essen, Essen, Germany., University Hospital S Giovanni Battista, Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, Turin, Italy., Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, Turin, Italy., Department of Urology, University Hospitals Leuven, Leuven, Belgium., Vita-Salute San Raffaele University, Milan, Italy; Department of Nuclear Medicine, IRCCS Ospedale San Raffaele, Milan, Italy., Department of Urology, OLV Hospital Aalst, Aalst, Belgium; Orsi Academy, Ghent, Belgium.