Incremental value of binary PSMA PET nodal status when added to Briganti-2019 and MSKCC models for predicting pathologic lymph node metastasis in prostate cancer Valor incremental de la incorporación del estado ganglionar determinado mediante PET-PSMA a los nomogramas Briganti-2019 y MSKCC para predecir metástasis ganglionares patológicas en cáncer de próstata
Actas Urologicas Espanolas, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Basım Tarihi: 2026
- Doi Numarası: 10.1016/j.acuro.2026.502004
- Dergi Adı: Actas Urologicas Espanolas
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, MEDLINE, DIALNET
- Anahtar Kelimeler: Lymph node, Nomograms, Prostate cancer, PSMA
- Dokuz Eylül Üniversitesi Adresli: Evet
Özet
Objective: To evaluate whether adding PSMA PET–detected lymph node involvement to established nomograms (Briganti-2019 and MSKCC) improves prediction of pathologic lymph node metastasis (LNM) in prostate cancer. Materials and methods: Retrospective, registry-based, multi-center cohort coordinated by the Turkish Urooncology Association, with data from 10 centers. We included 301 men undergoing radical prostatectomy with extended pelvic lymph node dissection (ePLND) and preoperative 68 Ga-PSMA PET/CT. For each nomogram, we fitted a baseline model and a model with the addition of PSMA PET nodal involvement (positive/negative). Discrimination (AUC) was compared using the DeLong test; model fit with the likelihood-ratio (LR) test; clinical utility with decision curve analysis (DCA). Results: For Briganti-2019, AUC numerically increased from 0.744 to 0.828 (ΔAUC + 0.084; DeLong p = 0.342), with improved fit (Δ–2LL 12.633; p < 0.001). For MSKCC, AUC numerically increased from 0.813 to 0.830 (ΔAUC + 0.017; DeLong p = 0.620), with better fit (Δ–2LL 9.306; p = 0.002). DCA showed a consistent net-benefit gain for Briganti-2019 with PSMA PET across 5–20% thresholds (largest around 15%), whereas gains for MSKCC were modest and confined to higher thresholds. Conclusion: Adding PSMA PET/CT nodal status improved model fit and suggested potential incremental clinical utility, particularly for Briganti-2019; however, statistically significant improvement in discrimination was not demonstrated by DeLong testing. PSMA PET/CT and clinical nomograms may be considered complementary tools for selecting candidates for ePLND.