Reconsidering the role of pelvic lymph node dissection with radical prostatectomy for prostate cancer in an era of improving radiological staging techniques

Yaxley, John; Dagher, Julien; Delahunt, Brett; Egevad, Lars; Srigley, John R.; Samaratunga, Hemamali

doi:10.1007/s00345-017-2119-0

Cited by 19 publications

(11 citation statements)

References 28 publications

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“…We found primary lymph node landing sites were outside an ePLND in 47.7% of men with suspected node‐positive disease on 68 Ga‐PSMA PET/CT. This is very important, as the morbidity of a PLND could be avoided, given the change in expectation of management from one of curative intent, to management that will require a multimodality approach after treatment of the prostate primary . Equally, for primary staging, a positive 68 Ga‐PSMA PET/CT in one pelvic node region commonly indicates multiple histological lymph node metastases.…”

Section: Discussionmentioning

confidence: 99%

Risk of metastatic disease on ⁶⁸gallium‐prostate‐specific membrane antigen positron emission tomography/computed tomography scan for primary staging of 1253 men at the diagnosis of prostate cancer

et al. 2019

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ConclusionsThese results support the use of 68 Ga-PSMA PET/CT for primary staging of prostate cancer. Increasing PSA level, ISUP grade and radiological staging with mpMRI were all statistically significant prognostic factors for metastasis on both univariate and multivariate analysis. KeywordsPET PSMA scan, primary staging, #PCSM, #ProstateCancer [Corrections added on 23 January 2020 after online publication: A new reference (23) has been added. In the Discussion section, the reference cue for the cross-sectional retrospective analysis of 220 men with newly diagnosed prostate cancer has been corrected, and the information relating to skeletal metastasis based on PSA levels has been corrected.]

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Section: Discussionmentioning

confidence: 99%

Risk of metastatic disease on ⁶⁸gallium‐prostate‐specific membrane antigen positron emission tomography/computed tomography scan for primary staging of 1253 men at the diagnosis of prostate cancer

et al. 2019

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“…30 We ultimately had an overall rate of PLND of 44.25% (118/265). Reports of overall rates of PLND performed in RRP populations vary greatly in the literature (26.34–100%) 12 13 31 likely a result of differing proportions of high-risk disease, local policies, and the existence of a variety of nomograms and guidance sources, with the National Comprehensive Cancer Network (NCCN) guidelines 32 and d'Amico risk stratification, 33 for example, also frequently used. Of patients undergoing pelvic lymph node dissection, our 11.86% (14/118) detection rate of nodal metastases is higher than that reported in other studies (reported rates range: 3.4–9.65%) 12 13 14 31 34 This may reflect both higher proportions of more aggressive or locally advanced disease in this cohort compared with that of other series, as discussed above, and also a lower overall PLND rate suggesting a more stringent criteria for proceeding to nodal dissection.…”

Section: Discussionmentioning

confidence: 99%

Oncological Outcomes of Open Radical Retropubic Prostatectomy in Ireland: A Single Surgeon's 5-Year Experience

Croghan

Matanhelia

Foran

et al. 2018

Surg J

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Objectives There is a little published data on the outcomes of radical prostatectomy in the Irish context. We aimed to determine the 5-year oncological results of open radical retropubic prostatectomy (RRP) performed by a single surgeon following appointment. Methods A retrospective review of RRPs performed between 2011 and 2016 was conducted. Patient demographics, preoperative parameters (clinical stage on digital rectal exam, prostate-specific antigen (PSA) levels, biopsy Gleason's score and MRI [magnetic resonance imaging] findings), pathological variables (T-stage, Gleason's score, nodal status, and surgical margin status), and treatment decisions (lymphadenectomy or adjuvant radiotherapy) were recorded. Oncological outcome at last follow-up was ascertained. Results 265 patients underwent RRP between 2011 and 2016. Median age was 62 years (range: 41–74). Mean follow-up was 32.24 months (range: 8–72) months. Pathological disease stage was T2 in 170/265 (64.15%), T3a in 65/265 (24.53%), and T3b in 30/265 (11.32%). Final Gleason's score was upgraded from diagnostic biopsy in 16.35% (43/263) and downgraded in 27% (71/263). Pelvic lymph node dissection was performed in 44.25% (118/265) patients. A positive surgical margin (PSM) was seen in 26/170 (15.2%) patients with T2 disease and in 45/95 (47.37%) patients with T3 disease. Of the 265 patients, 238 (89.81%) were disease-free at last follow-up, of whom 24/238 (10.08%) had received adjuvant and 17/238 (7.14%) received salvage radiotherapy. Adjuvant/salvage treatment was ongoing in 19/265 (7.17%) of patients. Conclusion Good oncological outcomes of RRP in the Irish context are seen in this 5-year review, with the vast majority of patients experiencing biochemical-free survival at most recent follow-up.

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“…These nomograms do not incorporate the findings of modern imaging modalities. However, most men have benign lymph node histology on PLND and the number of PLNDs required to improve oncological outcomes above that obtained from the RP procedure alone is high [12]. There is also the potential for significant morbidity with an ePLND [13].…”

Section: Introductionmentioning

confidence: 99%

Histological comparison between predictive value of preoperative 3‐T multiparametric MRI and ⁶⁸Ga‐PSMA PET/CT scan for pathological outcomes at radical prostatectomy and pelvic lymph node dissection for prostate cancer

et al. 2020

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To evaluate the ability of preoperative multiparametric magnetic resonance imaging (mpMRI) and a gallium-68 prostatespecific membrane antigen positron emission tomography/computed tomography (68 Ga-PSMA PET/CT) scan to predict pathological outcomes and also identify a group of men with a <5% risk of histological pelvic lymph node metastasis (LNM) at pelvic lymph node dissection (PLND) performed during a robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer. We then aimed to compare these results to known risk calculators for LNM, including the Cancer of the Prostate Risk Assessment (CAPRA) score, Memorial Sloan Kettering Cancer Centre (MSKCC) and Briganti nomograms. Patients and Methods Between July 2014 and September 2019 only men who had both a preoperative mpMRI and staging 68 Ga-PSMA PET/CT at our institution followed by a RALP with PLND referred to a single specialist uropathology laboratory were considered for inclusion. The data were collected retrospectively prior to February 2019 and in a prospective manner thereafter. A model was built to allocate probabilities of the men with a negative 68 Ga-PSMA PET/CT scan having a <5% risk of histologically LNM at RALP based on the preoperative radiological staging. Results A total of 233 consecutive men met the inclusion criteria of which 58 men (24.9%) had a LNM identified on PLND histology. The median (range) International Society of Urological Pathology (ISUP) Grade was 5 (1-5) and the median (range) prostate-specific antigen level was 7.4 (1.5-72) ng/mL. The median (range) number of resected lymph nodes was 16 (1-53) and the median (range) number of positive nodes identified on histology was 2 (1-22). Seminal vesicle invasion on mpMRI was more common in node-positive men than in the absence of LNM (31% vs 12%). The maximum standardised uptake value of the primary tumour on 68 Ga-PSMA PET/CT was higher in men with LNM (median 9.2 vs 7.2, P = 0.02). Suspected LNM were identified in 42/233 (18.0%) men with 68 Ga-PSMA PET/CT compared with 22/233 (9.4%) men with mpMRI (P = 0.023). The positive and negative predictive value for 68 Ga-PSMA PET/CT was 66.7% and 84.3% respectively, compared to 59.1% and 78.7% for mpMRI. A predictive model showed only two men (4.2%) with a negative preoperative 68 Ga-PSMA PET/CT would be positive for a histological LNM if they are ISUP Grade < 5 and Prostate Imaging-Reporting and Data System (PI-RADS) <5; or ISUP Grade 5 with PI-RADS < 4. An inspection of three additional variables: CAPRA score, MSKCC and Briganti nomograms did not improve the predictive probability for this group. However, of the 61 men with ISUP Grade 4-5 malignancy and also a PI-RADS 5 mpMRI, 20 (32.8%) men had a microscopic LNM despite a negative preoperative 68 Ga-PSMA PET/CT.

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Reconsidering the role of pelvic lymph node dissection with radical prostatectomy for prostate cancer in an era of improving radiological staging techniques

Cited by 19 publications

References 28 publications

Risk of metastatic disease on ⁶⁸gallium‐prostate‐specific membrane antigen positron emission tomography/computed tomography scan for primary staging of 1253 men at the diagnosis of prostate cancer

Risk of metastatic disease on ⁶⁸gallium‐prostate‐specific membrane antigen positron emission tomography/computed tomography scan for primary staging of 1253 men at the diagnosis of prostate cancer

Oncological Outcomes of Open Radical Retropubic Prostatectomy in Ireland: A Single Surgeon's 5-Year Experience

Histological comparison between predictive value of preoperative 3‐T multiparametric MRI and ⁶⁸Ga‐PSMA PET/CT scan for pathological outcomes at radical prostatectomy and pelvic lymph node dissection for prostate cancer

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Reconsidering the role of pelvic lymph node dissection with radical prostatectomy for prostate cancer in an era of improving radiological staging techniques

Cited by 19 publications

References 28 publications

Risk of metastatic disease on 68gallium‐prostate‐specific membrane antigen positron emission tomography/computed tomography scan for primary staging of 1253 men at the diagnosis of prostate cancer

Risk of metastatic disease on 68gallium‐prostate‐specific membrane antigen positron emission tomography/computed tomography scan for primary staging of 1253 men at the diagnosis of prostate cancer

Oncological Outcomes of Open Radical Retropubic Prostatectomy in Ireland: A Single Surgeon's 5-Year Experience

Histological comparison between predictive value of preoperative 3‐T multiparametric MRI and 68Ga‐PSMA PET/CT scan for pathological outcomes at radical prostatectomy and pelvic lymph node dissection for prostate cancer

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Risk of metastatic disease on ⁶⁸gallium‐prostate‐specific membrane antigen positron emission tomography/computed tomography scan for primary staging of 1253 men at the diagnosis of prostate cancer

Risk of metastatic disease on ⁶⁸gallium‐prostate‐specific membrane antigen positron emission tomography/computed tomography scan for primary staging of 1253 men at the diagnosis of prostate cancer

Histological comparison between predictive value of preoperative 3‐T multiparametric MRI and ⁶⁸Ga‐PSMA PET/CT scan for pathological outcomes at radical prostatectomy and pelvic lymph node dissection for prostate cancer