Esen Baris, Seymen Hulya, Armutlu Ayşe, Koseoglu Ersin, Aykanat Ibrahim Can, Zoroğlu Hatice, Canda Abdullah Erdem, Kordan Yakup, Balbay Mevlana Derya, Baydar Dilek Ertoy, Demirkol Mehmet Onur, Tilki Derya, Esen Tarık
Department of Urology, Koc University Hospital, Istanbul, Turkiye.
Department of Nuclear Medicine, Koc University Hospital, Istanbul, Turkiye.
Prostate. 2025 Jun;85(8):777-783. doi: 10.1002/pros.24884. Epub 2025 Feb 27.
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.
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.
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).
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.
前列腺特异性膜抗原（PSMA）正电子发射断层扫描/计算机断层扫描（PET/CT）先前已显示出在前列腺癌（PCa）淋巴结分期方面具有卓越性能，可用于减少不必要的盆腔淋巴结清扫术（PLND）的数量。本研究旨在评估PSMA PET/CT在中危前列腺癌淋巴结分期中的性能，并评估PLND对PSMA PET/CT结果为阴性的中危前列腺癌患者肿瘤学结局的影响。
本研究纳入了2014年1月至2024年7月期间共308例因淋巴结分期接受PSMA PET/CT检查的中危PCa患者。接受PLND的患者前列腺特异性抗原（PSA）水平更高，前列腺影像报告和数据系统（PIRADS）-5类及活检分级组3级疾病的发生率更高。进行1:1倾向评分匹配以消除组间患者特征差异，最终纳入140例患者进行分析。记录根治性前列腺切除术（RP）后PSA持续率（≥0.1 ng/dL）和生化复发（BCR；≥0.2 ng/dL）率。构建Kaplan-Meier曲线以评估肿瘤学结局。采用对数秩检验比较接受和未接受PLND患者的肿瘤学结局。
PSMA PET/CT在淋巴结分期方面的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为53.3%、95%、47.1%和96.1%。PSMA PET/CT在活检GG3级疾病患者中的NPV（96.3%）与活检GG2级疾病患者中的NPV（95.6%）相似。倾向评分匹配后的中位随访时间为20.7个月。PLND-RP组和单纯RP组的24个月无BCR生存率分别为83.7%和86.9%（p = 0.078）。
PSMA PET/CT在确定中危PCa患者淋巴结转移方面的NPV显著，且发现PLND对肿瘤学结局无影响。因此，对于PSMA PET/CT淋巴结分期为阴性的中危PCa患者，可省略PLND以减少手术相关并发症。
