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Purpose of Review <p>PSMA PET has reshaped prostate cancer staging by detecting low-volume nodal metastases occult on conventional imaging. This review summarizes current evidence on miN1M0 disease and discusses features that may guide surgical decision-making.</p> Recent Findings <p>Evidence remains heterogeneous, and the role of surgery in miN1M0 disease is undefined. Contemporary series suggest that surgery may be feasible within multimodal treatment in selected patients, supporting that miN1M0 disease should not automatically preclude surgery. Surgical candidacy should consider nodal burden and location, local tumor extent, tumor biology, and technical resectability. Low-volume pelvic nodal disease may represent the most plausible surgical scenario, whereas multiple positive nodes, extra-pelvic involvement, locally advanced disease, and adverse biology suggest higher systemic risk.</p> Summary <p>miN1 status should trigger individualized selection rather than surgical exclusion. Prospective studies are needed to clarify which patients may benefit from surgery within multimodal care.</p>

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Surgical Management of PSMA PET-Positive Lymph Nodes in Prostate Cancer

  • 期刊论文

  • 发表日期：

    2026年7月28日

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  • Andrea Cosenza,
  • Leonardo Quarta,
  • Armando Galdieri,
  • Michele Brancaccio,
  • Angelo Occhi,
  • Maria Elena Porzi,
  • Paolo Zaurito,
  • Alessandro Viti,
  • Alfonso Santangelo,
  • Pietro Scilipoti,
  • Simone Scuderi,
  • Francesco Barletta,
  • Armando Stabile,
  • Francesco Montorsi,
  • Alberto Briganti,
  • Giorgio Gandaglia

摘要

Purpose of Review

PSMA PET has reshaped prostate cancer staging by detecting low-volume nodal metastases occult on conventional imaging. This review summarizes current evidence on miN1M0 disease and discusses features that may guide surgical decision-making.

Recent Findings

Evidence remains heterogeneous, and the role of surgery in miN1M0 disease is undefined. Contemporary series suggest that surgery may be feasible within multimodal treatment in selected patients, supporting that miN1M0 disease should not automatically preclude surgery. Surgical candidacy should consider nodal burden and location, local tumor extent, tumor biology, and technical resectability. Low-volume pelvic nodal disease may represent the most plausible surgical scenario, whereas multiple positive nodes, extra-pelvic involvement, locally advanced disease, and adverse biology suggest higher systemic risk.

Summary

miN1 status should trigger individualized selection rather than surgical exclusion. Prospective studies are needed to clarify which patients may benefit from surgery within multimodal care.