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Purpose <p>To compare perioperative and early oncological outcomes of robotic radical prostatectomy (RP) with and without extended pelvic lymph node dissection (PLND) in a cohort of intermediate (IR)-to-high-risk (HR) prostate cancer (PCa) patients.</p> Methods <p>Data was prospectively collected from 88 patients (47 PLND, 41 no-PLND) with unfavorable intermediate- and high-risk miN0M0 PCa, all staged preoperatively with PSMA-PET/CT. Outcomes were assessed using Kaplan-Meier curves, uni-and multivariable Cox regression, for biochemical recurrence-free survival (BCRFS) and biochemical failure-free survival (BCFFS). A propensity score matched analysis with Cox regression was undertaken matching 1:1 for potential confounders (age, iPSA, preoperative ISUP, cT stage at MRI).</p> Results <p>Both groups (PLND and no-PLND) had the same proportion of HR patients (<i>p</i> = 1.0). The no-PLND group had a shorter median operative time by 50&#xa0;min (<i>p</i> &lt; 0.01). Conversely, the PLND group experienced significantly higher rates of 90-day high-grade complications (<i>p</i> = 0.03) and lymphoceles (<i>p</i> &lt; 0.01). Over a median 20.5-month follow-up, no significant differences emerged in BCRFS (<i>p</i> = 0.59) or BCFFS (<i>p</i> = 0.76). Uni- and multivariable analyses adjusted for UCSF CAPRA and CAPRA-S variables, as well as propensity score matching, confirmed PLND was not associated with improved BCFFS. In patients who did recur, the sites of recurrence did not differ between the two groups (<i>p</i> = 0.62), with pelvic nodal recurrence being the most common site of recurrence in both groups (6, 50% for PLND and 3, 60% for no-PLND).</p> Conclusions <p>In this short-term follow-up, performing PLND increased high-grade postoperative complications without providing a clear early oncological benefit regarding BCRFS, PSA persistence, or recurrence location.</p>

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The utility of pelvic lymph node dissection in PSMA-PET negative intermediate and high-risk prostate cancer patients undergoing radical prostatectomy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月11日

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  • Giuseppe Reitano,
  • R. Jeffrey Karnes,
  • Giacomo Novara,
  • Daniel S. Roberson,
  • Mohamed E. Ahmed,
  • Filippo Carletti,
  • Umar Ghaffar,
  • Giuseppe Dinoi,
  • Salvatore Carrozza,
  • Maurizio Bentivoglio,
  • Simone Botti,
  • Carlo Prevato,
  • Giovanni Betto,
  • Fabio Zattoni,
  • Fabrizio Dal Moro

摘要

Purpose

To compare perioperative and early oncological outcomes of robotic radical prostatectomy (RP) with and without extended pelvic lymph node dissection (PLND) in a cohort of intermediate (IR)-to-high-risk (HR) prostate cancer (PCa) patients.

Methods

Data was prospectively collected from 88 patients (47 PLND, 41 no-PLND) with unfavorable intermediate- and high-risk miN0M0 PCa, all staged preoperatively with PSMA-PET/CT. Outcomes were assessed using Kaplan-Meier curves, uni-and multivariable Cox regression, for biochemical recurrence-free survival (BCRFS) and biochemical failure-free survival (BCFFS). A propensity score matched analysis with Cox regression was undertaken matching 1:1 for potential confounders (age, iPSA, preoperative ISUP, cT stage at MRI).

Results

Both groups (PLND and no-PLND) had the same proportion of HR patients (p = 1.0). The no-PLND group had a shorter median operative time by 50 min (p < 0.01). Conversely, the PLND group experienced significantly higher rates of 90-day high-grade complications (p = 0.03) and lymphoceles (p < 0.01). Over a median 20.5-month follow-up, no significant differences emerged in BCRFS (p = 0.59) or BCFFS (p = 0.76). Uni- and multivariable analyses adjusted for UCSF CAPRA and CAPRA-S variables, as well as propensity score matching, confirmed PLND was not associated with improved BCFFS. In patients who did recur, the sites of recurrence did not differ between the two groups (p = 0.62), with pelvic nodal recurrence being the most common site of recurrence in both groups (6, 50% for PLND and 3, 60% for no-PLND).

Conclusions

In this short-term follow-up, performing PLND increased high-grade postoperative complications without providing a clear early oncological benefit regarding BCRFS, PSA persistence, or recurrence location.