The following is a summary of “Benefit and harm of lymphadenectomy in intermediate risk prostate cancer: comparison of five nomograms,” published in the November 2023  issue of Urology by Lodeta, et al.

Pelvic lymph node dissection (PLND) is commonly recommended for detecting nodal metastases in prostate cancer (PCa) patients, but it poses risks of serious complications. For a study, researchers sought to evaluate the balance between the benefits and harms of routine PLND in intermediate-risk PCa patients and compare the diagnostic yield of five different nomograms in predicting lymph node invasion (LNI).

A retrospective analysis was conducted on consecutive PCa patients with an intermediate risk of biochemical recurrence who underwent open radical prostatectomy with bilateral PLND. Various nomograms, including Partin, 2012-Briganti, 2018-Briganti, Cagiannos, and Memorial Sloan Kettering Cancer Center (MSKCC), were used to calculate values. Accuracy, sensitivity, specificity, and area under the receiver-operating curve (AUC) were compared. To assess the benefit and harm of PLND, relative risk (RR) and the number needed to treat (NNT) with LNI and complications as outcomes were calculated.

In the study involving 309 subjects, the average age was 62.2 years, and the average PSA level was 7.2 ng/mL. Among the participants, 18 (5.8%) had lymph node invasion (LNI), and 88 (28.5%) experienced Clavien-Dindo grade 3–5 complications. The area under the curve (AUC) for predicting LNI varied across nomograms: 0.729 for 2012-Briganti, 0.660 for MSKCC, 0.521 for 2018-Briganti, 0.486 for Cagiannos, and 0.424 for Partin. Pairwise AUC comparisons based on default and newly established cutoff values did not yield statistically significant differences. The lowest number needed to treat (NNT) was observed for Partin and Cagiannos with the default cutoff (≥ 5%). The risks of serious complications between higher and lower than cutoff values were non-significant across the nomograms, suggesting that the choice of nomogram may not significantly impact the risk of complications in these patients.

While the 2012 Briganti nomogram showed better performance in classifying LNI in intermediate-risk PCa patients, the risks associated with complications argue against routine PLND in the patient group.

Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-023-01362-y