The Predictive Value of Preoperative Negative Prostate Specific Membrane Antigen Positron Emission Tomography Imaging for Lymph Node Metastatic Prostate Cancer

No AccessJournal of UrologyAdult Urology1 Jun 2021The Predictive Value of Preoperative Negative Prostate Specific Membrane Antigen Positron Emission Tomography Imaging for Lymph Node Metastatic Prostate CancerThis article is commented on by the following:Editorial Comment Dennie Meijer, Hilda A. de Barros, Pim J. van Leeuwen, Yves J. L. Bodar, Henk G. van der Poel, Maarten L. Donswijk, N. Harry Hendrikse, R. Jeroen A. van Moorselaar, Jakko A. Nieuwenhuijzen, Daniela E. Oprea-Lager, and André N. Vis Dennie MeijerDennie Meijer *Correspondence: De Boelelaan 1117, 1081 HVAmsterdam, The Netherlands telephone: +31-20-4443289; FAX: +31-20-4446031; email: E-mail Address: [email protected] http://orcid.org/0000-0002-8298-575X Amsterdam University Medical Center, VU University, Department of Urology, Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands Amsterdam University Medical Center, VU University, Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, The Netherlands More articles by this author , Hilda A. de BarrosHilda A. de Barros The Netherlands Cancer Institute, Department of Urology, Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands More articles by this author , Pim J. van LeeuwenPim J. van Leeuwen The Netherlands Cancer Institute, Department of Urology, Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands More articles by this author , Yves J. L. BodarYves J. L. Bodar Amsterdam University Medical Center, VU University, Department of Urology, Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands Amsterdam University Medical Center, VU University, Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, The Netherlands More articles by this author , Henk G. van der PoelHenk G. van der Poel The Netherlands Cancer Institute, Department of Urology, Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands More articles by this author , Maarten L. DonswijkMaarten L. Donswijk The Netherlands Cancer Institute, Department of Nuclear Medicine, Amsterdam, The Netherlands More articles by this author , N. Harry HendrikseN. Harry Hendrikse Amsterdam University Medical Center, VU University, Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, The Netherlands Amsterdam University Medical Center, VU University, Department of Clinical Pharmacology and Pharmacy, Amsterdam, The Netherlands More articles by this author , R. Jeroen A. van MoorselaarR. Jeroen A. van Moorselaar Amsterdam University Medical Center, VU University, Department of Urology, Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands More articles by this author , Jakko A. NieuwenhuijzenJakko A. Nieuwenhuijzen Amsterdam University Medical Center, VU University, Department of Urology, Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands The Netherlands Cancer Institute, Department of Urology, Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands More articles by this author , Daniela E. Oprea-LagerDaniela E. Oprea-Lager Amsterdam University Medical Center, VU University, Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, The Netherlands More articles by this author , and André N. VisAndré N. Vis Amsterdam University Medical Center, VU University, Department of Urology, Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands The Netherlands Cancer Institute, Department of Urology, Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001592AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We sought to identify a subset of patients in whom an extended pelvic lymph node dissection during robot-assisted laparoscopic radical prostatectomy for localized prostate cancer could be omitted when preoperative prostate specific membrane antigen positron emission tomography showed no lymph node metastatic prostate cancer. Materials and Methods: A total of 434 patients who underwent prostate specific membrane antigen positron emission tomography prior to robot-assisted laparoscopic radical prostatectomy and extended pelvic lymph node dissection were retrospectively analyzed. Patients were excluded from analysis when the prostate specific membrane antigen positron emission tomography showed evidence of distant metastases. The primary outcome was whether a negative for metastases prostate specific membrane antigen positron emission tomography was able to correctly rule out pelvic lymp node metastases after extended pelvic lymph node dissection, ie its negative predictive value. Results: Overall sensitivity, specificity, positive predictive value and negative predictive value of prostate specific membrane antigen positron emission tomography for the detection of pelvic lymp node metastases were 37.9%, 94.1%, 64.3% and 84.4%, respectively. The negative predictive value of prostate specific membrane antigen positron emission tomography in patients with intermediate risk prostate cancer was 91.6% (95% CI 86–97), compared to 81.4% (95% CI 77–86) in patients with high risk prostate cancer. When only assessing patients with