PSMA PET has reshaped prostate cancer staging by detecting low-volume nodal metastases occult on conventional imaging. This review summarizes current evidence on miN1M0 disease and discusses features that may guide surgical decision-making.
Evidence remains heterogeneous, and the role of surgery in miN1M0 disease is undefined. Contemporary series suggest that surgery may be feasible within multimodal treatment in selected patients, supporting that miN1M0 disease should not automatically preclude surgery. Surgical candidacy should consider nodal burden and location, local tumor extent, tumor biology, and technical resectability. Low-volume pelvic nodal disease may represent the most plausible surgical scenario, whereas multiple positive nodes, extra-pelvic involvement, locally advanced disease, and adverse biology suggest higher systemic risk. miN1 status should trigger individualized selection rather than surgical exclusion. Prospective studies are needed to clarify which patients may benefit from surgery within multimodal care.
Current urology reports. 2026 Jul 28*** epublish ***
Andrea Cosenza, Leonardo Quarta, Armando Galdieri, Michele Brancaccio, Angelo Occhi, Maria Elena Porzi, Paolo Zaurito, Alessandro Viti, Alfonso Santangelo, Pietro Scilipoti, Simone Scuderi, Francesco Barletta, Armando Stabile, Francesco Montorsi, Alberto Briganti, Giorgio Gandaglia
Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy., Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy. .