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First page of Oncological Outcomes of Patients Undergoing Radical Prostatectomy with Extended versus Indocyanine-Guided Lymphadenectomy: Mid-Term Follow-Up of PersonalymPCa Clinical Trial

Background: Extended pelvic lymphadenectomy (ePLND) is the gold standard for staging prostate cancer (PCa) in patients at risk of lymph node invasion (LNI), though its oncological benefit remains debated. Indocyanine green-guided PLND (ICG-PLND) has emerged as a less morbid alternative, but its long-term oncological efficacy compared to ePLND is unclear. Methods: This extended follow-up of a randomized clinical trial (N=108) compared ICG-PLND (n=54) with ePLND (n=54) in patients undergoing radical prostatectomy. ICG-PLND involved selective removal of fluorescent nodes, while ePLND followed a standardized template. Primary outcomes included biochemical recurrence (BCR), metastatic progression, and secondary treatment rates. Median follow-up was 52 months. Results: No significant differences were observed in 52 months BCR free survival rates (ICG-PLND: 71% vs. ePLND: 73%, p = NS) or pelvic recurrence (ICG: 4 patients vs. ePLND: 2 patients). Distant metastases occurred in 6 ICG and 2 ePLND patients. ICG-PLND detected more pN1 disease (28%) despite fewer nodes removed (median 7 vs. 24, p < 0.001). Complication rates remained lower with ICG-PLND (32% vs. 70%, p < 0.001). Conclusions: ICG-PLND demonstrated comparable mid-term oncological outcomes to ePLND while significantly reducing morbidity. These findings support ICG-PLND as a safer, targeted alternative for nodal staging in PCa, though longer follow-up is needed to validate survival outcomes. Keywords: prostate cancer, lymphadenectomy, indocyanine green, complications, biochemical recurrence

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S. Karger AG, Basel
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2025
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