Pelvic lymph node management in prostate cancer: a narrative review

IF 2.6 2区 医学 Q2 UROLOGY & NEPHROLOGY
Bryan Chong , Vincent Khor , Jing Xue Hoo , Alvin Lee , Yu Guang Tan , Henry Ho , Christopher Cheng , Kae Jack Tay , Jeffrey Tuan , John Yuen , Kenneth Chen
{"title":"Pelvic lymph node management in prostate cancer: a narrative review","authors":"Bryan Chong ,&nbsp;Vincent Khor ,&nbsp;Jing Xue Hoo ,&nbsp;Alvin Lee ,&nbsp;Yu Guang Tan ,&nbsp;Henry Ho ,&nbsp;Christopher Cheng ,&nbsp;Kae Jack Tay ,&nbsp;Jeffrey Tuan ,&nbsp;John Yuen ,&nbsp;Kenneth Chen","doi":"10.1016/j.prnil.2025.02.001","DOIUrl":null,"url":null,"abstract":"<div><div>Pelvic lymph node management plays an important role in the staging and treatment of early prostate cancer, especially for higher risk patients. This narrative review explores the current practices and emerging techniques, including advanced imaging, surgical techniques, and radiotherapeutic strategies. The introduction of prostate-specific membrane antigen (PSMA) positron emission tomography/ computed tomography (PET/CT) has revolutionized nodal staging, offering improved diagnostic accuracy compared to conventional imaging modalities. However, pelvic lymph node dissection (PLND) remains the gold standard, albeit with significant morbidity and uncertain survival benefits due to its invasive nature. Less invasive approaches, such as sentinel lymph node biopsy and radioguided surgery, are promising techniques which aim to reduce procedural morbidity, while maintaining a reasonable standard of staging accuracy. We also explored the role of extended lymph node dissection (ePLND), which suggests potential oncological benefits in selected patients. Additionally, advancements in radiation therapy, including whole-pelvic irradiation guided by predictive risk scores offer alternative modalities for managing node-positive disease. However, the current heterogeneity in clinical protocols and outcomes highlights the need for more standardization and robust comparative studies. This review highlights the evolving paradigm of pelvic lymph node management, advocating for personalized approaches that integrate molecular imaging and emerging technologies to optimize outcomes for prostate cancer patients.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"13 3","pages":"Pages 128-136"},"PeriodicalIF":2.6000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Prostate International","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2287888225000054","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Pelvic lymph node management plays an important role in the staging and treatment of early prostate cancer, especially for higher risk patients. This narrative review explores the current practices and emerging techniques, including advanced imaging, surgical techniques, and radiotherapeutic strategies. The introduction of prostate-specific membrane antigen (PSMA) positron emission tomography/ computed tomography (PET/CT) has revolutionized nodal staging, offering improved diagnostic accuracy compared to conventional imaging modalities. However, pelvic lymph node dissection (PLND) remains the gold standard, albeit with significant morbidity and uncertain survival benefits due to its invasive nature. Less invasive approaches, such as sentinel lymph node biopsy and radioguided surgery, are promising techniques which aim to reduce procedural morbidity, while maintaining a reasonable standard of staging accuracy. We also explored the role of extended lymph node dissection (ePLND), which suggests potential oncological benefits in selected patients. Additionally, advancements in radiation therapy, including whole-pelvic irradiation guided by predictive risk scores offer alternative modalities for managing node-positive disease. However, the current heterogeneity in clinical protocols and outcomes highlights the need for more standardization and robust comparative studies. This review highlights the evolving paradigm of pelvic lymph node management, advocating for personalized approaches that integrate molecular imaging and emerging technologies to optimize outcomes for prostate cancer patients.
前列腺癌盆腔淋巴结管理:叙述回顾
盆腔淋巴结管理在早期前列腺癌的分期和治疗中起着重要的作用,特别是对于高危患者。这篇叙述性综述探讨了当前的实践和新兴技术,包括先进的成像、手术技术和放射治疗策略。前列腺特异性膜抗原(PSMA)正电子发射断层扫描/计算机断层扫描(PET/CT)的引入彻底改变了淋巴结分期,与传统成像方式相比,提供了更高的诊断准确性。然而,盆腔淋巴结清扫(PLND)仍然是金标准,尽管其侵袭性具有显著的发病率和不确定的生存效益。侵入性较小的方法,如前哨淋巴结活检和放射引导手术,是很有前途的技术,旨在减少手术发病率,同时保持合理的分期准确性标准。我们还探讨了扩大淋巴结清扫(ePLND)的作用,这表明在选定的患者中有潜在的肿瘤益处。此外,放射治疗的进步,包括由预测风险评分指导的全盆腔照射,为管理淋巴结阳性疾病提供了替代方式。然而,目前临床方案和结果的异质性突出了需要更多的标准化和可靠的比较研究。这篇综述强调了骨盆淋巴结管理的发展模式,提倡结合分子成像和新兴技术的个性化方法来优化前列腺癌患者的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Prostate International
Prostate International Medicine-Urology
CiteScore
4.40
自引率
26.70%
发文量
40
审稿时长
35 days
期刊介绍: Prostate International (Prostate Int, PI), the official English-language journal of Asian Pacific Prostate Society (APPS), is an international peer-reviewed academic journal dedicated to basic and clinical studies on prostate cancer, benign prostatic hyperplasia, prostatitis, and ...
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信