淋巴结转移（LNMs）在中高风险前列腺癌（PC）中很常见，可能会在扩展盆腔淋巴结清扫（ePLND）期间被忽略。在此，我们报告使用前列腺特异性膜抗原（PSMA）放射引导手术（RGS）在开放式根治性前列腺切除术（RP）中进行ePLND，以切除术前PSMA正电子发射断层扫描（PET）发现的局部淋巴结转移（LNMs）。 2018年1月至2020年6月期间，在接受RP和ePLND以及RGS治疗的35名患者中，术前PSMA PET显示有78个LNMs。在14位患者（40％）中，LNMs位于ePLND模板之外。在33/35名患者（94％）中，RGS可以切除PSMA阳性的LNMs。在单变量分析中，术前PET上最多两个PSMA阳性LNMs的较低转移负荷与术后的良好效果相关。限制包括回顾性分析和样本量较小。RGS有助于切除RP治疗的患者的PSMA阳性淋巴结。我们的数据显示，术前PSMA PET中低转移LN负荷的患者具有良好的治疗结果。 患者摘要：我们调查了使用放射性引导来去除手术切除前列腺中受前列腺癌影响的淋巴结。 这种方法可以帮助确定可能被忽视的癌性淋巴结，并可能导致更好的生存结果。 版权所有© 2022年欧洲泌尿外科协会。 由Elsevier B.V.发表。 保留所有权利。

Lymph node metastases (LNMs) are common in intermediate- to high-risk prostate cancer (PC) and may be missed during extended pelvic lymph node dissection (ePLND). Here we report on the use of prostate-specific membrane antigen (PSMA)-radioguided surgery (RGS) during open radical prostatectomy (RP) with ePLND to resect locoregional LNMs identified on preoperative PSMA positron emission tomography (PET). Preoperative PSMA PET showed 78 LNMs in 35 patients undergoing RP with ePLND and RGS between January 2018 and June 2020. In 14 patients (40%), LNMs were located outside the ePLND template. RGS achieved resection of PSMA-positive LNMs in 33/35 patients (94%). On univariable analysis, lower metastatic burden with up to two PSMA-positive LNMs on preoperative PET was associated with better postoperative outcomes. Limitations include the retrospective analysis and the small sample size. RGS facilitates resection of PSMA-positive LNs in patients treated with RP. Our data indicate a favorable treatment outcome in patients with low metastatic LN burden on preoperative PSMA PET. PATIENT SUMMARY: We investigated the use of radioactive guidance to remove lymph nodes affected by prostate cancer during surgical removal of the prostate. This approach can help to identify cancerous lymph nodes that might otherwise be missed and could lead to better survival outcomes.Copyright © 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.