THE IMPORTANCE OF SURGICAL CHOICE ON LYMPH NODE DISSECTION
In the surgical treatment of prostate cancer, one of the most debated issues concerns when it is necessary to also remove the pelvic lymph nodes during the main operation. This procedure, called extended pelvic lymph node dissection, is useful for understanding if the tumor has spread to the lymph nodes, but involves greater surgical risks. The decision becomes even more complex when dealing with patients with intermediate-high risk prostate cancer who, however, do not show visible signs of lymph node metastases on advanced radiological examinations such as PSMA PET.
It's like having to decide whether to open all the rooms in a house to look for something that might not be there: you want to be sure, but you don't want to create unnecessary damage. For this reason, predictive tools called nomograms have been developed, which are like “risk calculators” that help surgeons understand which patients might actually benefit from this additional procedure.
STUDY AND RESULTS OF THE BRIGANTI 2023 NOMOGRAM
The decision was made to evaluate five different available nomograms, focusing in particular on the most recent version of the Briganti 2023 nomogram. The study analyzed 282 patients with no visible signs of lymph node metastases who underwent radical prostatectomy with lymph node removal in ten different centers between 2016 and 2023.
The results show that the Briganti 2023 nomogram demonstrated the best accuracy rate in predicting the risk of lymph node invasion, with an effectiveness of 77%. This translated into the greatest clinical benefit compared to the other tools analyzed. Using a risk threshold of 5%, the application of this nomogram would have avoided approximately 47% of unnecessary lymph node removal procedures, with a missed diagnosis rate of lymph node invasion of only 3.8% of cases.
CLINICAL IMPLICATIONS AND TREATMENT PERSONALIZATION
It was observed that the Briganti 2023 nomogram represents a particularly effective clinical support tool, useful for reducing the over-treatment rate and improving the selection of optimal candidates for lymph node dissection.
The study conducted by Dr. Giorgio Gandaglia, URI researcher, demonstrates how the use of accurate predictive tools not only helps to better personalize treatments for each individual patient, but also represents a concrete way to make prostate cancer treatment more precise and less invasive when possible.
Gandaglia G, Barletta F, Scuderi S, Scilipoti P, Rajwa P, Huebner NA, Gomez Rivas J, Ibanez L, Soeterik TFW, Bianchi L, Mattei A, Kesch C, Darr C, Guo H, Zhuang J, Zattoni F, Fendler WP, Marra G, Stabile A, Robesti D, Amparore D, Joniau S, Schiavina R, Sierra JM, Porpiglia F, Picchio M, Chiti A, Mottrie A, van den Bergh RCN, Shariat SF, Montorsi F, Briganti A.
External Validation of Nomograms for the Identification of Pelvic Nodal Dissection Candidates Among Prostate Cancer Patients with Negative Preoperative Prostate-specific Membrane Antigen Positron Emission Tomography.
Eur Urol Oncol. 2025 Jan 30:S2588-9311(25)00004-5.
doi: 10.1016/j.euo.2025.01.004.
Epub ahead of print. PMID: 39890547.
