{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T13:49:34Z","timestamp":1790171374572,"version":"4.1.0"},"reference-count":10,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Prostate"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Prostate\u2010specific membrane antigen positron emission tomography\/computed tomography (PSMA PET\/CT) is increasingly used for pelvic nodal staging in prostate cancer and is often incorporated into radiotherapy decision\u2010making. However, the negative predictive value of PSMA PET\/CT for microscopic nodal disease remains imperfect. This study aimed to determine the true rate of occult pelvic lymph node metastases in patients with negative PSMA PET\/CT using surgical histopathology as the reference standard.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective surgical validation study included 51 patients with intermediate\u2010 or high\/very high\u2010risk prostate cancer and negative pelvic lymph node findings on preoperative \u2076\u2078Ga\u2010PSMA PET\/CT. All patients underwent radical prostatectomy with extended pelvic lymph node dissection between January 2021 and December 2024. Histopathological lymph node status (pN) served as the primary outcome. Clinical, imaging, and pathological variables were analyzed for associations with occult nodal metastases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Despite negative PSMA PET\/CT findings, 6 of 51 patients (11.8%) had histopathologically confirmed pelvic lymph node metastases. Patients with pN+ disease were significantly older (median: 70 vs. 64 years,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.019) and had higher preoperative PSA levels (mean: 24.85 vs. 12.95\u2009ng\/mL,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006). pN+ status was also associated with higher preoperative nodal risk scores. No significant differences were observed for Gleason grade group, clinical T stage, lymphovascular invasion, perineural invasion, or cribriform morphology between pN+ and pN\u2212 groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Negative PSMA PET\/CT does not reliably exclude microscopic pelvic lymph node metastases in intermediate\u2010 and high\/very high\u2010risk prostate cancer. These findings demonstrate a biologically relevant false\u2010negative rate for PSMA\u2010based nodal staging. While this study does not assess radiotherapy outcomes, the presence of occult nodal disease in PSMA\u2010negative patients supports a cautious, risk\u2010adapted approach to treatment de\u2010escalation strategies involving pelvic nodal irradiation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pros.70124","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T19:14:32Z","timestamp":1769109272000},"page":"648-654","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Pelvic Lymph Node Staging With PSMA PET in Prostate Cancer: Surgical Validation With Implications for Radiotherapy Planning"],"prefix":"10.1002","volume":"86","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9219-6001","authenticated-orcid":false,"given":"Alaattin","family":"Ozen","sequence":"first","affiliation":[{"name":"Basaksehir Cam ve Sakura City Hospital, Radiation Oncology Clinic Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9830-7824","authenticated-orcid":false,"given":"Zeynep","family":"Sarikaya","sequence":"additional","affiliation":[{"name":"Basaksehir Cam ve Sakura City Hospital, Radiation Oncology Clinic Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0127-9490","authenticated-orcid":false,"given":"Cansu","family":"Gur","sequence":"additional","affiliation":[{"name":"Basaksehir Cam ve Sakura City Hospital, Radiation Oncology Clinic Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0034-4274","authenticated-orcid":false,"given":"Direnc","family":"Ozboru","sequence":"additional","affiliation":[{"name":"Basaksehir Cam ve Sakura City Hospital Urology Clinic Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6481-7907","authenticated-orcid":false,"given":"Halil Lutfi","family":"Canat","sequence":"additional","affiliation":[{"name":"Basaksehir Cam ve Sakura City Hospital Urology Clinic Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30314-7"},{"key":"e_1_2_13_3_1","unstructured":"National Comprehensive Cancer Network Prostate Cancer (Version 2.2025). NCCN Clinical Practice Guidelines in Oncology (NCCN 2025) https:\/\/www.nccn.org."},{"issue":"3","key":"e_1_2_13_4_1","first-page":"479","article-title":"PSMA PET for Primary Prostate Cancer Diagnosis and Staging: A Meta\u2010Analysis","volume":"6","author":"Ceci F.","year":"2020","journal-title":"European Urology Focus"},{"issue":"4","key":"e_1_2_13_5_1","first-page":"209","article-title":"New Imaging Modalities in Prostate Cancer","volume":"11","author":"Murphy D. G.","year":"2014","journal-title":"Nature Reviews Urology"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/bju.13540"},{"issue":"4","key":"e_1_2_13_7_1","first-page":"540","article-title":"Primary Staging of Prostate Cancer With 68Ga\u2010PSMA PET\/CT in the Context of the PRIMARY Trial","volume":"63","author":"Sathekge M. M.","year":"2022","journal-title":"Journal of Nuclear Medicine"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2019.0096"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.03282"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(05)70348-X"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(10)70223-0"}],"container-title":["The Prostate"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pros.70124","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pros.70124","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pros.70124","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T15:31:53Z","timestamp":1789486313000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pros.70124"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,22]]},"references-count":10,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1002\/pros.70124"],"URL":"https:\/\/doi.org\/10.1002\/pros.70124","archive":["Portico"],"relation":{},"ISSN":["0270-4137","1097-0045"],"issn-type":[{"value":"0270-4137","type":"print"},{"value":"1097-0045","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,22]]},"assertion":[{"value":"2025-08-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}