Patients with prostate cancer who have pelvic lymph node metastases visualized on preoperative prostate-specific membrane antigen (PSMA) PET/CT staging have a significantly higher risk for biochemical disease progression after robot-assisted radical prostatectomy (RARP), compared with those without pelvic lymph node metastases on imaging, according to research published in BJU International.
The retrospective study included 145 patients who underwent PSMA PET/CT lymph node staging prior to RARP and had pelvic lymph node metastases found on extended pelvic lymph node dissection. The median biochemical progression-free survival was 7.9 months among the 49 patients (34%) whose preoperative imaging revealed pelvic lymph node metastases, compared with 13.7 months for the 96 patients (66%) whose preoperative imaging did not.
In addition, the presence of more than 2 tumor-positive lymph nodes, compared with 1-2, was significantly associated with a nearly 2-fold increased risk for biochemical progression, after adjustment for multiple variables. A larger diameter of the largest nodal metastasis was significantly associated with a 12% increased risk.
The investigators defined biochemical progression as a prostate-specific antigen (PSA) level of 0.2 ng/mL or higher during follow-up or the initiation of additional treatment.
The median diameter of the largest nodal metastasis was significantly larger among the patients with vs without nodal metastases found on preoperative PSMA PET/CT lymph node staging (6 mm vs 3 mm).
At final histopathologic evaluation, the median biochemical progression-free survival for patients with 1 or 2 tumor-positive lymph nodes was 14.9 months compared with 3.9 months for patients who had more than 2 tumor-positive lymph nodes.
Among patients with nodal metastases visualized on preoperative PSMA PET/CT, only the diameter of the largest nodal metastasis was significantly associated with biochemical progression; the number of tumor-positive lymph nodes was not. Among patients with no nodal metastases seen on PSMA PET/CT, both the presence of more than 2 positive lymph nodes and the diameter of the largest nodal metastasis were significantly associated with biochemical progression.
Meijer D, Ettema RH, van Leeuwen PJ et al. The prognostic value of lymph node staging with prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) and extended pelvic lymph node dissection in node-positive patients with prostate cancer. BJU Int. Published online September 7, 2022. doi:10.1111/bju.15881
This article originally appeared on Renal and Urology News