Impact of Pelvic Lymph Node Dissection on Early Oncological Outcomes in Intermediate‐Risk Prostate Cancer Patients With Node‐Negative PSMA PET - Esen - The Prostate - Wiley Online Library

Skip Lymph Node Disection During Surgery for Medium Risk PC

New Research Suggests PLND May Be Unnecessary for Some Prostate Cancer Patients

A recent study published in the Wiley Online Library offers promising news for men with intermediate-risk prostate cancer. Researchers have found that pelvic lymph node dissection (PLND) – a common but invasive procedure performed during radical prostatectomy – may be safely omitted in certain patients without compromising early cancer outcomes.

The Study at a Glance

Researchers evaluated nearly 400 patients with intermediate-risk prostate cancer who underwent radical prostatectomy (RP) between 2014 and 2024. They specifically focused on patients who had negative lymph nodes according to PSMA PET scans, a newer and more accurate imaging technique.

The study compared two groups of patients: those who underwent RP with PLND and those who had RP alone without PLND. After careful statistical matching to ensure fair comparison, researchers found no significant difference in biochemical recurrence-free survival rates between the two groups after two years of follow-up.

What is PLND and Why Does This Matter?

During radical prostatectomy, surgeons often remove nearby lymph nodes (PLND) to check if cancer has spread beyond the prostate and to potentially improve cancer outcomes. However, this procedure:

  • Increases surgery time
  • Can lead to complications like nerve injury, lymphocele (fluid collection), lymphedema (swelling), and blood clots
  • May not be necessary for all patients

The Role of PSMA PET Scans

The study highlights the value of PSMA PET/CT scans in determining whether lymph nodes are affected by cancer. These advanced scans were found to have a negative predictive value of 96.1%, meaning they correctly identified patients without lymph node involvement 96.1% of the time.

The researchers noted that when PSMA PET scans showed no cancer in lymph nodes, only 3.9% of these patients actually had lymph node involvement when examined after surgery. In practical terms, this means 25 PLND procedures would need to be performed to detect just one case of lymph node involvement missed by PSMA PET.

What This Means for Patients

If you have intermediate-risk prostate cancer and your PSMA PET scan shows no cancer in the lymph nodes, this research suggests that:

  1. The likelihood of having cancer in your lymph nodes is very low (less than 4%)
  2. Skipping the PLND procedure may allow you to avoid potential complications
  3. Your cancer outcomes may not be negatively affected by omitting this procedure

The lead researcher, Dr. Baris Esen, concluded: "PLND might be omitted to decrease surgery-related complications in patients with intermediate-risk prostate cancer and a negative PSMA PET/CT for nodal staging."

What's Next?

While these findings are promising, the researchers acknowledge some limitations. The study is retrospective (looking back at past cases rather than designing a controlled trial), has a relatively short follow-up period of about 21 months, and includes a limited number of patients.

The research team recommends that further prospective studies (designed from the start to track outcomes over time) are needed to confirm these findings before clinical practice guidelines can be changed.

Talk to Your Doctor

If you have intermediate-risk prostate cancer and are discussing treatment options with your doctor, you might want to ask about:

  • Whether a PSMA PET scan is appropriate in your case
  • The potential benefits and risks of PLND in your specific situation
  • How these new findings might apply to your treatment plan

As always, medical decisions should be made in consultation with your healthcare team, taking into account your individual circumstances and preferences.

This article summarizes research published in the Wiley Online Library. The original study was conducted by Baris Esen and colleagues.

Impact of Pelvic Lymph Node Dissection on Early Oncological Outcomes in Intermediate‐Risk Prostate Cancer Patients With Node‐Negative PSMA PET - Esen - The Prostate - Wiley Online Library

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