Depending on the risk of LN metastasis ePLND at RP is recommended. As ePLND has potential side effects, and diagnostics have improved substantially, our objective was to evaluate the performance of the Briganti 2019 nomogram in a contemporary cohort with preoperative negative PSMA-PET.
Patients with intermediate- and high-risk prostate cancer (CaP), undergoing RP and ePND at our center with preoperative negative [68Ga]Ga-PSMA-11 PET were included. The Accuracy of the nomogram was assessed using ROC analysis. The association of clinical parameters with the presence of LN metastasis was assessed using logistic regression. Specimen of prostate and LNs in patients with false negative PSMA-PET were additionally stained for AR and PSMA expression and assessed by IHC.
The study included 108 patients, 28% intermediate- and 72% high-risk. Twelve patients harbored occult LN metastasis. Accuracy of the nomogram was 0.62. [68Ga]Ga-PSMA-11 PET showed a NPV of 89%. IHC showed expression of PSMA and AR in the primary and LN metastasis in all patients. On logistic regression analysis only DRE (OR 2.72; 95%CI 1.01-7.35; P = 0.05) and percentage of cores with significant CaP (OR 1.29; 95%CI 1.05-1.60; P = 0.02) showed a significant association with LN metastasis.
The currently used nomogram is suboptimal in detecting patients with occult LNM. While the cut-off value to perform ePLND can be increased slightly following a negative PSMA-PET scan, more accurate methods of identifying these patients are needed. Whether ePLND can have a therapeutic benefit, as opposed to a diagnostic only, needs to be re-evaluated in the PSMA-PET era.
Urologic oncology. 2024 Jan 20 [Epub ahead of print]
Nicolai A Huebner, Gabriel Wasinger, Pawel Rajwa, Irene Resch, Stephan Korn, Sazan Rasul, Pascal Baltzer, Larissa Prüger, Andreas Rauschmeier, Christian Seitz, Eva Comperat, Shahrokh F Shariat, Bernhard Grubmüller
Department of Urology, Medical University of Vienna, Vienna, Austria; Working Group for Diagnostic imaging in Urology (ABDU), Austrian Association of Urology (ÖGU), Vienna, Austria. Electronic address: ., Department of Pathology, Medical University of Vienna, Vienna, Austria., Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland., Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Biomedical Imaging and Image guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria., Department of Biomedical Imaging and Image guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria., Department of Urology, Hospital Weinviertel Korneuburg, Korneuburg, Austria., Department of Urology, Medical University of Vienna, Vienna, Austria; Working Group for Diagnostic imaging in Urology (ABDU), Austrian Association of Urology (ÖGU), Vienna, Austria., Department of Urology, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, University of Texas Southwestern, Dallas, TX; Department of Urology and Division of Medical Oncology, Weill Medical College of Cornell University, New York, NY; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan., Department of Urology and Andrology, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria.