Abstract
Introduction: Extended pelvic lymphadenectomy (ePLND) is the gold standard for staging prostate cancer (PCa) in patients at risk of lymph node invasion, 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 the 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-month 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 being 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 midterm 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.
