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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

2023; Lippincott Williams & Wilkins; Volume: 210; Issue: 1 Linguagem: Inglês

10.1097/ju.0000000000003442

1527-3792

Alberto Martini, Lieke Wever, Timo Soeterik, Arnas Rakauskas, Christian D. Fankhauser, Josias Bastian Grogg, Enrico Checcucci, Daniele Amparore, Luciano Haiquel, Lara Rodríguez‐Sánchez, Guillaume Ploussard, Peng Qiang, Andres Affentranger, Alessandro Marquis, Giancarlo Marra, Otto Ettala, Fabio Zattoni, Ugo Giovanni Falagario, Mario de Angelis, Claudia Kesch, Maria Apfelbeck, Tarek Al‐Hammouri, Alexander Kretschmer, Veeru Kasivisvanathan, Felix Preißer, Emilie Lefebvre, Jonathan Olivier, Jan Philipp Radtke, Alberto Briganti, Francesco Montorsi, Giuseppe Carrieri, Fabrizio Moro, Peter J. Boström, Ivan Jambor, Paolo Gontero, Peter Ka‐Fung Chiu, Hubert John, Petr Macek, Francesco Porpiglia, Thomas Hermanns, Roderick C.N. van den Bergh, Jean‐Paul A. van Basten, Giorgio Gandaglia, Massimo Valério,

Urologic and reproductive health conditions

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.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.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.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.