Who Still Needs a Lymph Node Dissection With a Negative PSMA-PET? Resutls From the Michigan Urological Surgery Improvement Collaborative
Document Type
Conference Proceeding
Publication Date
5-2025
Publication Title
Journal of Urology
Abstract
NTRODUCTION AND OBJECTIVE: PSMA-PET is increasingly used to stage men with prostate cancer to assess for disease in regional lymph nodes (LNs) and/or distant metastasis. We assessed the concordance of clinical N stage (cN) assessed by preoperative PSMA-PET with pathology N stage (pN) in real world data from the Michigan Urological Surgery Improvement Collaborative (MUSIC). METHODS: MUSIC collects data from 46 urology practices in Michigan. We reviewed the registry for men who had a PSMA-PET prior to radical prostatectomy (RP) with pelvic LN dissection (PLND) and compared PSMA-PET results for pelvic LN involvement (cN) with pathology reports (pN) to determine the positive (PPV) and negative predictive value (NPV) of PSMA-PET. We compared pathology grade group (GG), PSA, and pathologic T stage between cN0/pN1 and cN0/pN0 patients using Fisher’s exact and Wilcoxon rank sum tests. RESULTS: 359 men had PSMA-PET prior to RP/PLND, of which 327 were cN0, 21 were cN1, and 11 were cNx. Of 327 cN0patients, 299 were pN0 and 28 were pN1. Of 21 men with cN1 scans,15 were pN0 and 6 were pN1. This corresponds to a NPV and PPV of 91% (299/327) and 29% (6/21), respectively. Of 28 cN0/pN1patients, 43%, 4%, 29%, and 25% had GG5, GG4, GG3, and GG2disease on final pathology, respectively, compared with 18%, 10%,41%, and 31% of cN0/pN0 patients (Table 1, p=0.049). Median PSA was similar among patients with cN0/pN1 disease (PSA 11, IQR: 6-26) and cN0/pN0 disease (PSA 9, IQR: 6-15, p=0.2). A higher proportion of cN0/pN1 patients were classified as NCCN high risk preoperatively compared with cN0/pN0 patients (65% vs. 54%, p=0.4). The pathological stage for patients with cN0/pN1 disease was notably higher (p< 0.001), with 96% of patients with cN0/pN1disease having pT3a/b disease compared with 57% of patients with cN0/pN0 disease. CONCLUSIONS: Preoperative cN stage assessed by PSMA-PET in MUSIC had high NPV and low PPV. Patients that were cN0/pN1 were predictably higher risk compared with patients with cN0/pN0 disease, which may inform future efforts to refine which patients with cN0 PSMA-PET staging should undergo PLND. While the NPV of PSMA-PET in the MUSIC cohort was similar to previously published studies (w80%), the PPV was notably lower (29%vs.w75%). This raises questions regarding the quality of PLND and may inform future quality improvement efforts to ensure patients with prostate cancer and high risk of pelvic LN metastasis receive appropriate quality PLND.
Volume
213
Issue
5S
First Page
e479
Last Page
e479
Recommended Citation
Moser AM, Lewicki P, Meah S, Labardee C, Lane BR, Borza T, et al. [Hafron J, Gadzinski AJ, Ginsburg KB]. Who still needs a lymph node dissection with a negative PSMA-PET? Results from the Michigan Urological Surgery Improvement Collaborative. J Urol. 2025 May;213(5S):e479. doi:10.1097/01.JU.0001109868.09667.98.12
DOI
10.1097/01.JU.0001109868.09667.98.12
Comments
American Urological Association Annual Meeting, April 26-29, 2025, Las Vegas, NV