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

IF 3.2 2区医学 Q2 UROLOGY & NEPHROLOGY

Current Urology Reports Pub Date : 2026-07-28 DOI:10.1007/s11934-026-01348-x

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

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Abstract

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. 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.

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前列腺癌PSMA pet阳性淋巴结的外科治疗。

回顾目的：PSMA PET通过检测常规影像中隐匿的小体积淋巴结转移来重塑前列腺癌的分期。本文综述了目前有关miN1M0疾病的证据，并讨论了可能指导手术决策的特征。最新发现：证据仍然不一致，手术在miN1M0疾病中的作用尚不明确。当前的一系列研究表明，在选定的患者中，在多模式治疗中手术是可行的，这支持miN1M0疾病不应自动排除手术。手术候选应考虑淋巴结负担和位置、局部肿瘤范围、肿瘤生物学和技术可切除性。小容量盆腔淋巴结疾病可能是最合理的手术方案，而多个阳性淋巴结、盆腔外受累性、局部晚期疾病和不良生物学反应提示更高的全身风险。miN1状态应引起个体化选择，而不是手术排除。需要前瞻性研究来阐明在多模式治疗中哪些患者可能从手术中获益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Urology Reports UROLOGY & NEPHROLOGY-

CiteScore

4.60

自引率

3.80%

发文量

期刊介绍： This journal intends to review the most important, recently published findings in the field of urology. By providing clear, insightful, balanced contributions by international experts, the journal elucidates current and emerging approaches to the care and prevention of urologic diseases and conditions. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as benign prostatic hyperplasia, erectile dysfunction, female urology, and kidney disease. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.