PSMA PET Scan Era: A Changing Paradigm PSMA PET and Lymph Node Dissection for Prostate Cancer Management.

Abstract

Staging of extra-prostatic prostate cancer has traditionally been assessed by computerised tomography (CT), bone scan, and where indicated, pelvic lymph node dissection at the time of surgery. The advent of the prostate-specific membrane antigen (PSMA) positron emission tomography (PET) scan shows promise in improving the accuracy of preoperative staging of this cancer. The role of pelvic lymph node dissection and its associated morbidity will be examined. This article will review current literature assessing the current role of PSMA PET and lymph node dissection in the staging and treatment of prostate cancer. Peer-reviewed literature and databases, including Medline and PubMed. PSMA PET/CT appears to be a promising and superior staging investigation that may replace bone scan and CT scan in guiding treatment decision-making. It has high specificity and positive predictive value, thus in patients with low-risk prostate cancer, unnecessary extended pelvic lymph node dissection (ePLND) may be avoided. It would also help detect lymph nodes in patients with intermediate- or high-risk prostate cancer where ePLND may be required. ePLND remains the gold standard in staging high-risk patients because the PSMA PET/CT scan may under-stage the cancer. Given the increased utilisation of PSMA PET/CT scan as a primary staging investigation in clinical practice for prostate cancer and as an alternative to bone scan and CT scan, it is timely for prostate cancer specialist nurses to understand and recognise the specificity and sensitivity of PSMA PET/CT scans in prostate cancer staging. Because ePLND is the gold standard for staging high-risk disease, prostate cancer specialist nurses should be aware of the complications associated with pelvic lymph node dissection to optimise supportive care for men affected by complications from ePLND.