Prostate-specific Membrane Antigen-radioguided Surgery Facilitates Pelvic Lymph Node Dissection During Radical Prostatectomy for the Treatment of Locally Advanced Prostate Cancer with Regional Lymph Node Metastases

Lymph node metastases (LNMs) are common in intermediate-to high-risk prostate cancer (PC) and may be missed during extended pelvic lymph node dissection (ePLND). Here we report on the use of prostate-specific membrane antigen (PSMA)-radioguided surgery (RGS) during open radical prostatectomy (RP) with ePLND to resect locoregional LNMs identified on preoperative PSMA positron emission tomography (PET). Preoperative PSMA PET showed 78 LNMs in 35 patients undergoing RP with ePLND and RGS between January 2018 and June 2020. In 14 patients (40%), LNMs were located outside the ePLND template. RGS achieved resection of PSMA-positive LNMs in 33/35 patients (94%). On uni-variable analysis, lower metastatic burden with up to two PSMA-positive LNMs on preop-erative PET was associated with better postoperative outcomes. Limitations include the retrospective analysis and the small sample size. RGS facilitates resection of PSMA-positive LNs in patients treated with RP. Our data indicate a favorable treatment outcome in patients with low metastatic LN burden on preoperative PSMA PET.Patient summary: We investigated the use of radioactive guidance to remove lymph nodes affected by prostate cancer during surgical removal of the prostate. This approach can help to identify cancerous lymph nodes that might otherwise be missed and could lead to better survival outcomes.(c) 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Automated summary

This study investigated the use of prostate-specific membrane antigen (PSMA)-radioguided surgery (RGS) to remove locoregional lymph node metastases (LNMs) identified on preoperative PSMA positron emission tomography (PET) during open radical prostatectomy (RP) with extended pelvic lymph node dissection (ePLND). The results showed a high success rate (94%) of resecting PSMA-positive LNMs using RGS, with 40% of LNMs located outside the ePLND template. Patients with a lower metastatic burden on preoperative PSMA PET had better postoperative outcomes. The study has limitations including a retrospective analysis and a small sample size.