TY - JOUR
T1 - The Prognostic Role of Preoperative PSMA PET/CT in cN0M0 pN+ Prostate Cancer
T2 - A Multicenter Study
AU - EAU-Young Academic Urologists (YAU) Prostate Cancer Working Party (PCa-WP)
AU - Marra, Giancarlo
AU - Rajwa, Pawel
AU - Filippini, Claudia
AU - Ploussard, Guillaume
AU - Montefusco, Gabriele
AU - Puche-Sanz, Ignacio
AU - Olivier, Jonathan
AU - Zattoni, Fabio
AU - Moro, Fabrizio Dal
AU - Magli, Alessandro
AU - Dariane, Charles
AU - Affentranger, Andres
AU - Grogg, Josias Bastian
AU - Hermanns, Thomas
AU - Chiu, Peter K.
AU - Malkiewicz, Bartosz
AU - Kowalczyk, Kamil
AU - Van den Bergh, Roderick C.N.
AU - Shariat, Shahrokh F.
AU - Bianchi, Alberto
AU - Antonelli, Alessandro
AU - Gallina, Sebastian
AU - Berchiche, William
AU - Sanchez-Salas, Rafael
AU - Cathelineau, Xavier
AU - Afferi, Luca
AU - Fankhauser, Christian Daniel
AU - Mattei, Agostino
AU - Karnes, Robert Jeffrey
AU - Scuderi, Simone
AU - Montorsi, Francesco
AU - Briganti, Alberto
AU - Deandreis, Désirée
AU - Gontero, Paolo
AU - Gandaglia, Giorgio
AU - Matteo, Facco
AU - Tonetto, Fabrizio
AU - Soeterik, Timo
N1 - Publisher Copyright:
© 2023 The Author(s)
PY - 2024/4
Y1 - 2024/4
N2 - Context: Despite negative preoperative conventional imaging, up to 10% of patients with prostate cancer (PCa) harbor lymph-node involvement (LNI) at radical prostatectomy (RP). The advent of more accurate imaging modalities such as PET/CT improved the detection of LNI. However, their clinical impact and prognostic value are still unclear. We aimed to investigate the prognostic value of preoperative PET/CT in patients node positive (pN+) at RP. Evidence Synthesis: We retrospectively identified cN0M0 patients at conventional imaging (CT and/or MRI, and bone scan) who had pN+ PCa at RP at 17 referral centers. Patients with cN+ at PSMA/Choline PET/CT but cN0M0 at conventional imaging were also included. Systemic progression/recurrence was the primary outcome; Cox proportional hazards models were used for multivariate analysis. Evidence Acquisition: We included 1163 pN+ men out of whom 95 and 100 had preoperative PSMA and/or Choline PET/CT, respectively. ISUP grade ≥4 was detected in 66.6%. Overall, 42% of patients had postoperative PSA persistence (≥0.1 ng/mL). Postoperative management included initial observation (34%), ADT (22.7%) and adjuvant RT+/-ADT (42.8%). Median follow-up was 42 months. Patients with cN+ on PSMA PET/CT had an increased risk of systemic progression (52.9% vs. 13.6% cN0 PSMA PET/CT vs. 21.5% cN0 at conventional imaging; P < .01). This held true at multivariable analysis: (HR 6.184, 95% CI: 3.386-11-295; P < .001) whilst no significant results were highlighted for Choline PET/CT. No significant associations for both PET types were found for local progression, BCR, and overall mortality (all P > .05). Observation as an initial management strategy instead of adjuvant treatments was related with an increased risk of metastases (HR 1.808; 95% CI: 1.069-3.058; P < .05). Conclusions: PSMA PET/CT cN+ patients with negative conventional imaging have an increased risk of systemic progression after RP compared to their counterparts with cN0M0 disease both at conventional and/or molecular imaging.
AB - Context: Despite negative preoperative conventional imaging, up to 10% of patients with prostate cancer (PCa) harbor lymph-node involvement (LNI) at radical prostatectomy (RP). The advent of more accurate imaging modalities such as PET/CT improved the detection of LNI. However, their clinical impact and prognostic value are still unclear. We aimed to investigate the prognostic value of preoperative PET/CT in patients node positive (pN+) at RP. Evidence Synthesis: We retrospectively identified cN0M0 patients at conventional imaging (CT and/or MRI, and bone scan) who had pN+ PCa at RP at 17 referral centers. Patients with cN+ at PSMA/Choline PET/CT but cN0M0 at conventional imaging were also included. Systemic progression/recurrence was the primary outcome; Cox proportional hazards models were used for multivariate analysis. Evidence Acquisition: We included 1163 pN+ men out of whom 95 and 100 had preoperative PSMA and/or Choline PET/CT, respectively. ISUP grade ≥4 was detected in 66.6%. Overall, 42% of patients had postoperative PSA persistence (≥0.1 ng/mL). Postoperative management included initial observation (34%), ADT (22.7%) and adjuvant RT+/-ADT (42.8%). Median follow-up was 42 months. Patients with cN+ on PSMA PET/CT had an increased risk of systemic progression (52.9% vs. 13.6% cN0 PSMA PET/CT vs. 21.5% cN0 at conventional imaging; P < .01). This held true at multivariable analysis: (HR 6.184, 95% CI: 3.386-11-295; P < .001) whilst no significant results were highlighted for Choline PET/CT. No significant associations for both PET types were found for local progression, BCR, and overall mortality (all P > .05). Observation as an initial management strategy instead of adjuvant treatments was related with an increased risk of metastases (HR 1.808; 95% CI: 1.069-3.058; P < .05). Conclusions: PSMA PET/CT cN+ patients with negative conventional imaging have an increased risk of systemic progression after RP compared to their counterparts with cN0M0 disease both at conventional and/or molecular imaging.
KW - Functional imaging
KW - Lymph node
KW - Prognosis
KW - Treatment
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U2 - 10.1016/j.clgc.2023.11.006
DO - 10.1016/j.clgc.2023.11.006
M3 - Article
C2 - 38155081
AN - SCOPUS:85181138104
SN - 1558-7673
VL - 22
SP - 244
EP - 251
JO - Clinical Genitourinary Cancer
JF - Clinical Genitourinary Cancer
IS - 2
ER -