Abstract
Introduction
The urological community's opinion over the management of men being found with pathologically
positive nodes (pN+) following radical prostatectomy (RP) performed with curative
intent after preoperative negative conventional staging (cN0M0) has never been assessed.
This remains crucial, especially considering the advent of novel imaging modalities.
Our aim was to investigate the current opinion on management of pN+ cN0M0 prostate
cancer (PCa) in the European urological community.
Methods
Following validation, a 31-item survey, complying with the Cherries checklist, was
distributed using a web link from December 2021 to April 2022 to 10 urological societies
mailing list. Social media (Twitter, Facebook) were also used.
Results
We received 253 replies. The majority were Urologists (96.8%), younger than 60 (90.5%);
5.2% did not have access to PET-scans; 78.9% believed pN+ is a multifaceted category;
10-years CSS was marked as 71 to 95% by 17.5%. Gold standard management was stated
not being ADT by 80.8% and being RT±ADT by 52.3%. Early sRT±ADT was considered an
option vs. aRT±ADT by 72.4%. In case of BCR 71% would perform and decide management
based on PSMA-PET whilst 3.7% would not perform PSMA-PET. pN+ management is still
unclear for 77.1%. On multivariate analysis PSMA-PET availability related to a lower
and higher likelihood of considering aRT±ADT as standard and of considering early
salvage versus aRT respectively (P < .05).
Conclusions
The Urological community has an acceptable awareness of pN+ disease and management,
although it may overestimate disease aggressiveness. The majority consider pN+ PCa
as a multifaceted category and rely on a risk-adapted approach. Expectant compared
to immediate upfront management and new imaging modalities are increasingly considered.
Key Words
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Article info
Publication history
Published online: December 05, 2022
Accepted:
November 14,
2022
Received in revised form:
November 9,
2022
Received:
September 26,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Published by Elsevier Inc.
