Cystoscopic ICG-Guided Sentinel Lymph Node Dissection in Robotic Radical Prostatectomy: A Prospective Study

Area of Science:

• Urology
• Surgical Oncology
• Medical Imaging

Background:

• Nodal staging is crucial in prostate cancer management.
• Robotic-assisted radical prostatectomy (RaRP) is a standard treatment.
• Accurate sentinel lymph node dissection (SLND) can improve staging accuracy.

Purpose of the Study:

• To evaluate the diagnostic accuracy of a novel cystoscopic-guided indocyanine green (ICG) injection technique for SLND during RaRP.
• To assess the procedural feasibility and clinical outcomes of this CysICG-SLND method.
• To determine the utility of CysICG-SLND in different risk categories of prostate cancer patients.

Main Methods:

• Prospective enrollment of 34 patients with clinically localized prostate cancer (cT1-cT3, cN0) undergoing RaRP.
• Cystoscopic-guided intraprostatic ICG injections tailored to prostate size.
• Fluorescence-guided SLND using the da Vinci Xi Surgical System, followed by extended pelvic lymph node dissection (ePLND).

Main Results:

• CysICG-SLND was technically successful in all patients, with a 97.1% overall fluorescence detection rate.
• Per-patient sensitivity and negative predictive value (NPV) were excellent (100%).
• Per-node performance varied, being moderate overall and modest in high-risk patients, though NPV remained high (90.7%) in this group. Low- and intermediate-risk groups showed 100% NPV.

Conclusions:

• CysICG-SLND is a feasible and accurate method for nodal staging in prostate cancer, especially for low- to intermediate-risk patients.
• The technique demonstrates high per-patient accuracy, supporting its clinical utility despite limitations in per-node performance in high-risk cases.
• Larger studies are needed to confirm these findings and define the broader clinical role of CysICG-SLND.