Pelvic lymph node dissection for nodal oligometastatic prostate cancer detected by 68Ga‐PSMA‐positron emission tomography/computerized tomography. Issue 16 (10th September 2015) - Hijazi, S.
Abstract BACKGROUND The first evaluation of pelvic extended lymph node dissection (pLND) in oligometastatic prostate cancer (PCa) detected by 68Ga‐PSMA PET/CT. METHODS Retrospective analysis of 35 PCa patients underwent 68Ga‐PSMA PET/CT affected by biochemical recurrence (BCR) after curative treatment (n = 23) or before primary therapy of high‐risk PCa (n = 12). We performed pLND associated with pathologic imaging in 17 men with nodal oligometastatic PCa. RESULTS Indicative lesions for PCa in PET/CT were detected in 91.4% (32 of 35) of patients. Nodal, bone, visceral (pulmonary), and within the prostate suspected disease were detected in 72% (23 of 32), 16% (5 of 32), 6% (2 of 32), and 47% (15 of 32) of patients, respectively. Median serum PSA in patients with pathological radiotracer uptake in recurrent and high‐risk PCa patients was 2.9 ng/ml (range 0.18–30) and 19.5 ng/ml (range 6–90), respectively. The median number of removed lymph nodes with pLND in recurrent and high‐risk PCa was 10 (range 4–17) and 12 (range 8–29) per patient and the median number of positive lymph nodes was 1 (range 1–2) and 3 (2–3) per patient, respectively. In total, two false positive and one false‐negative lymph node were found. Diagnostic accuracies per nodal lesion in total of 213 removed nodes: sensitivity, 94%; specificity, 99%; positive predictive value (PPV), 89%, and negative predictive value (NPV), 99.5%. After pLND, 53% (9 of 17) of patients received androgen deprivation therapy and/or radiation therapy and hormonal therapy, while 47% (8 of 17) of patients remained free of any post‐surgery therapy. Follow‐up PSA remained less than 0.2 ng/ml in 82% (14 of 17) of patients. After pLND, immediate BCR (PSA never measured less than 0.2 ng/ml) in 18% (3 of 17) of patients was recorded. CONCLUSIONS This represents the first study of pLND in the setting of nodal oligometastatic PCa detected by 68Ga‐PSMA PET/CT. The use of 68Ga‐PSMA PET/CT could be to improve the accuracy for the detection of nodal micrometastases. These promising findings need validation in larger studies. Prostate 75:1934–1940, 2015. © 2015 Wiley Periodicals, Inc.