Can pelvic lymph node dissection be spared in intermediate-risk prostate cancer patients with negative PSMA PET scan? A systematic review and diagnostic meta-analysis.
Qi-Chang Wan, Kai-Yin Min, Lan Wei et al.
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In 30 seconds
This systematic review and diagnostic meta-analysis assessed PSMA PET/CT for detecting lymph node invasion in intermediate-risk prostate cancer and considered whether a negative scan could support omitting pelvic lymph node dissection (PLND). Twelve studies included 1,619 patients; study quality was moderate. Pooled sensitivity was 49% (95% confidence interval [CI] 27-72%), specificity was 95% (95% CI 93-97%), and negative predictive value was 95% (95% CI 91-98%). The authors suggest PLND may be omitted after a negative scan, while emphasizing the possibility of missed micrometastatic disease and the need for cautious decisions.
Key findings
- Across 12 studies and 1,619 patients, pooled PSMA PET/CT sensitivity for lymph node invasion was 49% (95% CI 27-72%).
- Pooled specificity was 95% (95% CI 93-97%), and pooled negative predictive value was 95% (95% CI 91-98%).
- The included studies were judged to have moderate methodological quality.
Why it matters
A negative PSMA PET/CT was associated with a high pooled negative predictive value, making omission of PLND a potential consideration for intermediate-risk disease. However, the modest pooled sensitivity means imaging can miss nodal involvement, including micrometastatic disease. The findings therefore frame a trade-off between avoiding dissection and accepting residual uncertainty about nodal status.
What to keep in mind
The evidence came from studies of moderate methodological quality, and pooled sensitivity was modest. The authors call for large prospective validation and follow-up focused on clinical outcomes.