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. 2025 Jun;85(8):777-783.
doi: 10.1002/pros.24884. Epub 2025 Feb 27.

Impact of Pelvic Lymph Node Dissection on Early Oncological Outcomes in Intermediate-Risk Prostate Cancer Patients With Node-Negative PSMA PET

Baris Esen  1 , Hulya Seymen  2 , Ayşe Armutlu  3 , Ersin Koseoglu  1 , Ibrahim Can Aykanat  1 , Hatice Zoroğlu  4 , Abdullah Erdem Canda  1   5 , Yakup Kordan  1 , Mevlana Derya Balbay  1 , Dilek Ertoy Baydar  3 , Mehmet Onur Demirkol  2 , Derya Tilki  1   6   7 , Tarık Esen  1
Affiliations

Impact of Pelvic Lymph Node Dissection on Early Oncological Outcomes in Intermediate-Risk Prostate Cancer Patients With Node-Negative PSMA PET

Baris Esen et al. Prostate. 2025 Jun.

Abstract

Background: PSMA PET/CT has previously shown superior performance in nodal staging of prostate cancer (PCa) and may be used to reduce the number of unnecessary PLND procedures. This study aims to assess the performance of PSMA PET/CT in nodal staging of intermediate-risk prostate cancer and to evaluate the effect of PLND on oncological outcomes of intermediate-risk prostate cancer patients with a negative PSMA PET/CT.

Methods: A total of 308 patients with intermediate-risk PCa who underwent PSMA PET/CT for nodal staging between January 2014 and July 2024 were included in the study. Patients who underwent PLND had higher PSA and higher rates of PIRADS-5 and biopsy grade-group 3 disease. A 1:1 propensity score matching was performed to eliminate patient characteristics differences between groups and 140 patients were included in the final analysis. PSA persistence rates ( ≥ 0.1 ng/dL) and biochemical recurrence (BCR; ≥ 0.2 ng/dL) rates after RP were recorded. Kaplan-Meier curves were constructed to evaluate oncological outcomes. Log-rank test was utilized to compare oncological outcomes in patients with and without PLND.

Results: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PSMA PET/CT on nodal staging were 53.3%, 95%, 47.1%, and 96.1%, respectively. The NPV of PSMA PET/CT in patients with biopsy GG3 disease (96.3%) was similar to those with biopsy GG2 disease (95.6%). The median follow-up after propensity score matching was 20.7 months. The 24-month BCR-free survival rates were 83.7% and 86.9% in the PLND-RP group and RP-only groups, respectively (p = 0.078).

Conclusions: NPV of PSMA PET/CT in determining LNI was remarkable in patients with intermediate-risk PCa and PLND was found to have no impact on oncological outcomes. Therefore PLND may be omitted to decrease surgery-related complications in patients with intermediate-risk PCa a negative PSMA PET/CT for nodal staging.

Keywords: PET; PSMA; intermediate; lymph node dissection; prostate cancer; staging.

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Conflict of interest statement

Abdullah Erdem Canda reports speaker honoraria for CONMED Corporation, congress expenses were covered by CORDAMED Biomedical Engineering.

Figures

Figure 1
Figure 1
Patient inclusion flow chart for different end‐points of the study; (1) The performance of PSMA PET/CT for nodal staging; (2) oncological outcomes before propensity score matching and (3) the analysis after propensity score matching.
Figure 2
Figure 2
Kaplan‐Meier curves comparing the biochemical recurrence‐free survival of patients who underwent PLND and those who did not undergo PLND before (A) and after (B) propensity score matching.
See this image and copyright information in PMC

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