How PSMA-PET can inform decision making on lymph-node dissection in prostate cancer

Jen-Jane Liu, MD, discusses how PSMA-PET imaging might help physicians decide whether or not a patient with prostate cancer needs lymph node dissection.

Jen-Jane Liu, MD, associate professor, urology, Oregon Health & Science University, discusses how PSMA-PET imaging can help in the decision making process regarding lymph-node dissection in prostate cancer.


The standard of care for determining whether or not a lymph node dissection should be performed is currently based on nomograms, where you input the patient's clinical information. And if that nomogram risk of detecting metastases is over anywhere from 2% to 5%, then it's generally recommended that a lymph node dissection is performed.

The reason not to just do one and everyone is there is added morbidity associated and potential complications with doing one. So we have long been in search of a very accurate way to enable us to identify patients in whom we can omit lymph node dissection. But we haven't really been able to figure that out yet.

I would say the data would suggest that PSMA-PET imaging by itself is not adequate to determine who you can omit a lymph node dissection on, and that's because there's about a 20% false-negative rate in this population of patients who you're looking to do surgery on. However, there is some data suggesting that combining PSMA-PET with other imaging modalities or other clinical parameters might help get us closer to a more accurate way of predicting which patients do need the lymph node dissection.

Transcript has been edited for clarity.

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