Unilateral Pelvic Lymph Node Dissection in Prostate Cancer Patients Diagnosed in the Era of Magnetic Resonance Imaging-targeted Biopsy: A Study That Challenges the Dogma

Alberto Martini, Lieke Wever, Timo F W Soeterik, Arnas Rakauskas, Christian Daniel Fankhauser, Josias Bastian Grogg, Enrico Checcucci, Daniele Amparore, Luciano Haiquel, Lara Rodriguez-Sanchez, Guillaume Ploussard, Peng Qiang, Andres Affentranger, Alessandro Marquis, Giancarlo Marra, Otto Ettala, Fabio Zattoni, Ugo Giovanni Falagario, Mario De Angelis, Claudia KeschMaria Apfelbeck, Tarek Al-Hammouri, Alexander Kretschmer, Veeru Kasivisvanathan, Felix Preisser, Emilie Lefebvre, Jonathan Olivier, Jan Philipp Radtke, Alberto Briganti, Francesco Montorsi, Giuseppe Carrieri, Fabrizio Dal Moro, Peter Boström, Ivan Jambor, Paolo Gontero, Peter K Chiu, Hubert John, Petr Macek, Francesco Porpiglia, Thomas Hermanns, Roderick C N van den Bergh, Jean-Paul A van Basten, Giorgio Gandaglia, Massimo Valerio

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Abstract

PURPOSE: Bilateral extended pelvic lymph node dissection at the time of radical prostatectomy is the current standard of care if pelvic lymph node dissection is indicated; often, however, pelvic lymph node dissection is performed in pN0 disease. With the more accurate staging achieved with magnetic resonance imaging-targeted biopsies for prostate cancer diagnosis, the indication for bilateral extended pelvic lymph node dissection may be revised. We aimed to assess the feasibility of unilateral extended pelvic lymph node dissection in the era of modern prostate cancer imaging.

MATERIALS AND METHODS: We analyzed a multi-institutional data set of men with cN0 disease diagnosed by magnetic resonance imaging-targeted biopsy who underwent prostatectomy and bilateral extended pelvic lymph node dissection. The outcome of the study was lymph node invasion contralateral to the prostatic lobe with worse disease features, ie, dominant lobe. Logistic regression to predict lymph node invasion contralateral to the dominant lobe was generated and internally validated.

RESULTS: Overall, data from 2,253 patients were considered. Lymph node invasion was documented in 302 (13%) patients; 83 (4%) patients had lymph node invasion contralateral to the dominant prostatic lobe. A model including prostate-specific antigen, maximum diameter of the index lesion, seminal vesicle invasion on magnetic resonance imaging, International Society of Urological Pathology grade in the nondominant side, and percentage of positive cores in the nondominant side achieved an area under the curve of 84% after internal validation. With a cutoff of contralateral lymph node invasion of 1%, 602 (27%) contralateral pelvic lymph node dissections would be omitted with only 1 (1.2%) lymph node invasion missed.

CONCLUSIONS: Pelvic lymph node dissection could be omitted contralateral to the prostate lobe with worse disease features in selected patients. We propose a model that can help avoid contralateral pelvic lymph node dissection in almost one-third of cases.

Original languageEnglish
Pages (from-to)117-127
Number of pages10
JournalThe Journal of urology
Volume210
Issue number1
DOIs
Publication statusPublished - Jul 2023
Externally publishedYes

Bibliographical note

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© 2023 Lippincott Williams and Wilkins. All rights reserved.

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