Amsterdam University Medical Center, VU University, Department of Urology, Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands.
Amsterdam University Medical Center, VU University, Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, The Netherlands.
J Urol. 2021 Jun;205(6):1655-1662. doi: 10.1097/JU.0000000000001592. Epub 2021 Feb 3.
We sought to identify a subset of patients in whom an extended pelvic lymph node dissection during robot-assisted laparoscopic radical prostatectomy for localized prostate cancer could be omitted when preoperative prostate specific membrane antigen positron emission tomography showed no lymph node metastatic prostate cancer.
A total of 434 patients who underwent prostate specific membrane antigen positron emission tomography prior to robot-assisted laparoscopic radical prostatectomy and extended pelvic lymph node dissection were retrospectively analyzed. Patients were excluded from analysis when the prostate specific membrane antigen positron emission tomography showed evidence of distant metastases. The primary outcome was whether a negative for metastases prostate specific membrane antigen positron emission tomography was able to correctly rule out pelvic lymp node metastases after extended pelvic lymph node dissection, ie its negative predictive value.
Overall sensitivity, specificity, positive predictive value and negative predictive value of prostate specific membrane antigen positron emission tomography for the detection of pelvic lymp node metastases were 37.9%, 94.1%, 64.3% and 84.4%, respectively. The negative predictive value of prostate specific membrane antigen positron emission tomography in patients with intermediate risk prostate cancer was 91.6% (95% CI 86-97), compared to 81.4% (95% CI 77-86) in patients with high risk prostate cancer. When only assessing patients with <rT3 disease on multiparametric magnetic resonance imaging, 51/52 patients with intermediate risk prostate cancer had a true negative prostate specific membrane antigen positron emission tomography (negative predictive value=98.1%; 95% CI 94-100).
In patients with high risk prostate cancer, extended pelvic lymph node dissection remains the gold standard staging method, as pelvic lymph node metastases are frequently missed in those with no lymph node metastatic prostate cancer on prostate specific membrane antigen positron emission tomography. Patients with intermediate risk prostate cancer and a radiological T-stage <rT3 on multiparametric magnetic resonance imaging are potential candidates to withhold an extended pelvic lymph node dissection in the presence of a "negative for lymph node metastases" prostate specific membrane antigen positron emission tomography.
我们试图确定一组患者，当术前前列腺特异性膜抗原正电子发射断层扫描（PSMA-PET）显示无淋巴结转移性前列腺癌时，可以省略机器人辅助腹腔镜根治性前列腺切除术中的扩大盆腔淋巴结清扫术。
回顾性分析了 434 例在机器人辅助腹腔镜根治性前列腺切除术前接受 PSMA-PET 检查并进行扩大盆腔淋巴结清扫术的患者。当 PSMA-PET 显示远处转移证据时，患者被排除在分析之外。主要结果是转移性 PSMA-PET 阴性是否能够正确排除扩大盆腔淋巴结清扫术后的盆腔淋巴结转移，即其阴性预测值。
PSMA-PET 检测盆腔淋巴结转移的总体敏感性、特异性、阳性预测值和阴性预测值分别为 37.9%、94.1%、64.3%和 84.4%。中危前列腺癌患者的 PSMA-PET 阴性预测值为 91.6%（95%CI 86-97），高危前列腺癌患者为 81.4%（95%CI 77-86）。当仅评估多参数磁共振成像（mpMRI）上<rT3 疾病的患者时，51/52 例中危前列腺癌患者的 PSMA-PET 结果为真阴性（阴性预测值=98.1%；95%CI 94-100）。
在高危前列腺癌患者中，扩大盆腔淋巴结清扫术仍然是金标准分期方法，因为 PSMA-PET 显示无淋巴结转移性前列腺癌的患者中，常遗漏盆腔淋巴结转移。对于 mpMRI 上的影像学 T 分期<rT3 的中危前列腺癌患者，如果 PSMA-PET 显示“无淋巴结转移”，则可能是不进行扩大盆腔淋巴结清扫术的候选者。
