PSMA PET/CT-guided pelvic lymph node dissection in patients with unfavorable intermediate- or high-risk prostate cancer

Eva Donck^1,*, Sofie Verbeke², Pieter De Visschere³, Valérie Fonteyne⁴, Charles Van Praet¹, Kathia De Man⁵, Nicolaas Lumen¹
1 Department of Urology, ERN UROGEN Accredited Center, Ghent University Hospital, Ghent, 9000, Belgium
2 Department of Pathology, Ghent University Hospital, Ghent, 9000, Belgium
3 Department of Radiology, Ghent University Hospital, Ghent, 9000, Belgium
4 Department of Radiation Oncology, Ghent University Hospital, Ghent, 9000, Belgium
5 Department of Medical Imaging (Nuclear Medicine), Ghent University Hospital, Ghent, 9000, Belgium
* Corresponding Author: Eva Donck. Email: email
(This article belongs to the Special Issue: Advances in Molecular Imaging and Targeted Therapies for Prostate Cancer)

Canadian Journal of Urology https://doi.org/10.32604/cju.2025.068589

Received 01 June 2025; Accepted 27 August 2025; Published online 09 December 2025

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Abstract

Objectives: PSMA PET/CT (Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography) offers improved accuracy in detecting lymph node invasion (LNI) in prostate cancer (PC) patients, potentially reducing the need for extended pelvic lymph node dissection (ePLND). This study aims to evaluate a patient-tailored care pathway in which ePLND is performed only in patients with unfavorable intermediate- or high-risk PC who are deemed at risk for LNI based on PSMA PET/CT findings. Methods: In this interventional cohort study, 81 patients were managed according to the new care pathway. ePLND was omitted in cases of negative PSMA PET/CT findings (N0M0), while those with positive PSMA PET/CT findings (N1M0) underwent ePLND. A comparator group of 81 patients was selected from a prospectively generated database for comparison. Results: The intervention group experienced a 75% reduction in the number of ePLNDs performed compared to the comparator group (p < 0.001). ePLND-related complications were significantly lower in the intervention group (p = 0.008). No significant difference was observed in 3-year biochemical-recurrence free survival (BRFS) between the two groups (p = 0.958). Conclusion: Omitting ePLND in patients with negative PSMA PET/CT findings (N0M0) leads to a substantial reduction in the number of ePLNDs performed, resulting in a decrease in morbidity, without compromising early oncological outcomes.