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Area of Science:

  • Urology
  • Radiology
  • Oncology

Background:

  • Lymph node metastases (LNM) are critical prognostic factors in prostate cancer (PCa).
  • Pelvic node dissection is the standard for LNM detection, but novel imaging aims to improve accuracy and reduce surgical burden.

Purpose of the Study:

  • To review and analyze emerging imaging techniques for detecting LNM in prostate cancer.
  • To explore the advantages and limitations of these advanced imaging modalities.

Main Methods:

  • A systematic literature search of the National Library of Medicine Database (2013-2018) was conducted.
  • Keywords included "Prostate", "Cancer", "staging", "Lymph Node", "imaging", and "MRI" or "PET".

Main Results:

  • DWI-MRI demonstrated 41% sensitivity and 94% specificity for lymph node invasion.
  • SPIO MRI achieved 96.4% sensitivity for LNM detection (5-10 mm short axis) versus 28.5% for MRI alone.
  • PSMA PET/CT shows significant growth for LNM detection and biochemical recurrence (BCR) evaluation; Fluciclovine PET may detect subcentimetric nodes.

Conclusions:

  • Molecular imaging, especially PSMA ligand PET, offers high diagnostic accuracy for LNM, including subcentimetric nodes.
  • DWI-MRI is effective for evaluating lymph node involvement, with SPIO contrast potentially enhancing detection rates.
  • Sentinel lymph node (SLN) techniques are experimental for PCa; prospective trials are needed to confirm the clinical impact of these imaging advancements.