Prostate international · 2025
Practice patterns of Urological Society of Australia and New Zealand urologists regarding pelvic lymph node dissection in prostate cancer surgery.
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Treacy Patrick-Julien, Thanigasalam Ruban, Bird Jacob, Alexander Kate, Hirst Nicholas, Li Thomas, Virk Amandeep, Karunaratne Sascha, Steffens Daniel, Cotte Juliette, Leslie Scott
Аннотация
BACKGROUND: The objective of this study was to investigate the current approach of urologists within the Urological Society of Australia and New Zealand (USANZ) regarding the clinical criteria and anatomical templates for performing pelvic lymph node dissection (PLND) for prostate cancer (PCa) patients in the era of magnetic resonance imaging (MRI) and prostate-specific membrane antigen (PSMA) positron emission tomography (PET) computed tomography imaging technologies.
MATERIALS AND METHODS: An online cross-sectional survey was distributed to all USANZ members. Participants were questioned about their expertise, surgical volume, clinical focus of practice, preoperative imaging approach, indications and anatomical description of PLND, and surgical approach.
RESULTS: Of the 611 members invited, 113 (18%) responded to the survey and were included. Most urologists were working in private practice (49%) and completed a uro-oncology fellowship (73%). Fifty-five percent had finished their training over 10 years ago. Forty-two percent had performed more than 50 procedures a year, and 60% of them were done robotically. Ninety-seven percent of urologists routinely performed a preoperative magnetic resonance imaging and 18% performed a systematic PSMA-PET scan. When performing more than one technique, the indication and extent of the PLND was dependent on the technique for 9% of urologists. The anatomical extent of the routine PLND was mainly obturator fossa and external iliac (98% and 68%, respectively). Most urologists performed bilateral PLND on unfavorable intermediate-/high-risk PCa patients (75%).
CONCLUSIONS: The findings of this survey offer a valuable understanding into the current practices of USANZ urologists regarding PLND in PCa surgery, which highlights the absence of consistency in determining the indication and extent of this procedure. PSMA-PET scans have an impact on the urologist's decision-making practices and therefore warrant further examination.
MATERIALS AND METHODS: An online cross-sectional survey was distributed to all USANZ members. Participants were questioned about their expertise, surgical volume, clinical focus of practice, preoperative imaging approach, indications and anatomical description of PLND, and surgical approach.
RESULTS: Of the 611 members invited, 113 (18%) responded to the survey and were included. Most urologists were working in private practice (49%) and completed a uro-oncology fellowship (73%). Fifty-five percent had finished their training over 10 years ago. Forty-two percent had performed more than 50 procedures a year, and 60% of them were done robotically. Ninety-seven percent of urologists routinely performed a preoperative magnetic resonance imaging and 18% performed a systematic PSMA-PET scan. When performing more than one technique, the indication and extent of the PLND was dependent on the technique for 9% of urologists. The anatomical extent of the routine PLND was mainly obturator fossa and external iliac (98% and 68%, respectively). Most urologists performed bilateral PLND on unfavorable intermediate-/high-risk PCa patients (75%).
CONCLUSIONS: The findings of this survey offer a valuable understanding into the current practices of USANZ urologists regarding PLND in PCa surgery, which highlights the absence of consistency in determining the indication and extent of this procedure. PSMA-PET scans have an impact on the urologist's decision-making practices and therefore warrant further examination.