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• W3127573510 abstract "No AccessJournal of UrologyAdult Urology1 Jun 2021Regional Lymph Node Metastasis on Prostate Specific Membrane Antigen Positron Emission Tomography Correlates with Decreased Biochemical Recurrence-Free and Therapy-Free Survival after Radical Prostatectomy: A Retrospective Single-Center Single-Arm Observational Study Thomas Amiel, Christoph Würnschimmel, Matthias Heck, Thomas Horn, Noemi Nguyen, Lars Budäus, Sophie Knipper, Mike Wenzel, Isabel Rauscher, Matthias Eiber, Hui Wang, and Tobias Maurer Thomas AmielThomas Amiel Department of Urology, Technical University of Munich, Munich, Germany Equal study contribution. More articles by this author , Christoph WürnschimmelChristoph Würnschimmel Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada Equal study contribution. More articles by this author , Matthias HeckMatthias Heck Department of Urology, Technical University of Munich, Munich, Germany More articles by this author , Thomas HornThomas Horn Department of Urology, Technical University of Munich, Munich, Germany More articles by this author , Noemi NguyenNoemi Nguyen Department of Urology, Technical University of Munich, Munich, Germany More articles by this author , Lars BudäusLars Budäus Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany More articles by this author , Sophie KnipperSophie Knipper Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany More articles by this author , Mike WenzelMike Wenzel Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany More articles by this author , Isabel RauscherIsabel Rauscher Department of Nuclear Medicine, Technical University of Munich, Munich, Germany Supported by grants from the National Institutes of Health, Howard Hughes Medical Institute, Wellcome Trust and Research Councils UK. More articles by this author , Matthias EiberMatthias Eiber Department of Nuclear Medicine, Technical University of Munich, Munich, Germany More articles by this author , Hui WangHui Wang Department of Nuclear Medicine, Technical University of Munich, Munich, Germany Equal study contribution. More articles by this author , and Tobias MaurerTobias Maurer §Correspondence: Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246Hamburg, Germany telephone: +49 (0)40 7410-51300; FAX: +49 (0)40 7410-51323; E-mail Address: [email protected] http://orcid.org/0000-0002-5660-7691 Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany Equal study contribution. More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001596AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We sought to address the impact of preoperative prostate specific membrane antigen (PSMA) positron emission tomography (PET) findings prior to radical prostatectomy and pelvic lymph node dissection on biochemical recurrence and time to adjuvant or salvage treatment. Materials and Methods: Between 2013 and 2017, 64 intermediate and 166 high risk (230) prostate cancer patients received 68Ga-PSMA-11 PET followed by radical prostatectomy and pelvic lymph node dissection. Biochemical recurrence-free and therapy-free survivalwere determined. For all time-to-event analyses, univariable and multivariable Cox proportional hazards models and univariable Kaplan-Meier analyses were applied, with a significance threshold of p <0.05. Results: The overall sensitivity, specificity, positive predictive value and negative predictive value of PSMA PET for pN1 disease was 48.5%, 95.7%, 82.1% and 82.2%, respectively. Median followup was 30.2 months. Biochemical recurrence occurred in 50.4% (116) of patients and adjuvant or salvage treatment was performed in 46.5% (107). Worst biochemical recurrence-free and therapy-free survival was observed in pN1 patients who also exhibited PSMA PET positive lymph node, followed by pN1 patients without PSMA PET positive lymph node and patients without evidence of lymph node metastasis on histology and PSMA PET (median biochemical recurrence-free survival 1.7 vs. 7.5 vs. >36 months, median therapy-free survival 2.6 vs. 8.9 vs. >36 months). Conclusions: Patients with positive lymph node on PSMA PET prior to radical prostatectomy have to expect early biochemical recurrence and adjuvant/salvage therapy, despite thorough pelvic lymph node dissection. Therefore, results from PSMA PET can be used for patients’ consultation and more stringent followup as well as for planning of neoadjuvant/adjuvant therapy. References 1. : EAU Guidelines on Prostate Cancer, Limited Update. Arnhem, The Netherlands: EAU Guidelines Office 2020. Available at https://uroweb.org/guideline/prostate-cancer/#. Google Scholar 2. National Comprehensive Cancer Network: Clinical Practice Guidelines on Prostate Cancer (version 2.2020—May 21, 2020). National Comprehensive Cancer Network2020. Available at https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf. Google Scholar 3. : The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol 2008; 63: 387. Google Scholar 4. : Performance characteristics of computed tomography in detecting lymph node metastases in contemporary patients with prostate cancer treated with extended pelvic lymph node dissection. Eur Urol 2012; 61: 1132. 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Link, Google Scholar 10. : Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet 2020; 395: 1208. Google Scholar 11. : PET imaging with a [68Ga]gallium-labelled PSMA ligand for the diagnosis of prostate cancer: biodistribution in humans and first evaluation of tumour lesions. Eur J Nucl Med Mol Imaging 2013; 40: 486. Google Scholar 12. : 68Ga-complex lipophilicity and the targeting property of a urea-based PSMA inhibitor for PET imaging. Bioconjug Chem 2012; 23: 688. Google Scholar 13. : Topography of lymph node metastases in prostate cancer patients undergoing radical prostatectomy and extended lymphadenectomy: results of a combined molecular and histopathologic mapping study. Eur Urol 2014; 66: 222. Google Scholar 14. : Evaluation of hybrid 68Ga-PSMA ligand PET/CT in 248 patients with biochemical recurrence after radical prostatectomy. J Nucl Med 2015; 56: 668. Google Scholar 15. : Simultaneous 68Ga-PSMA HBED-CC PET/MRI improves the localization of primary prostate cancer. Eur Urol 2016; 70: 829. Google Scholar 16. : Prostate cancer molecular imaging standardized evaluation (PROMISE): proposed miTNM classification for the interpretation of PSMA-ligand PET/CT. J Nucl Med 2018; 59: 469. Google Scholar 17. : A contemporary prostate cancer grading system: a validated alternative to the Gleason score. Eur Urol 2016; 69: 428. Google Scholar 18. R Core Team: R: A Language and Environment for Statistical Computing. Vienna, Austria:R Foundation for Statistical Computing 2013. Available at http://www.r-project.org/. Google Scholar 19. : 68Ga-PSMA PET/CT for primary NM staging of high-risk prostate cancer. J Nucl Med 2020; doi: 10.2967/jnumed.120.245605. Crossref, Google Scholar 20. : The benefits and harms of different extents of lymph node dissection during radical prostatectomy for prostate cancer: a systematic review. Eur Urol 2017; 72: 84. Google Scholar 21. : Prostate-specific membrane antigen–guided surgery. J Nucl Med 2020; 61: 6. Google Scholar 22. : Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial. Lancet 2018; 392: 2353. Google Scholar 23. : Outcome of patients with newly diagnosed prostate cancer with low metastatic burden treated with radical prostatectomy: a comparison to STAMPEDE arm H. World J Urol 2020; 38: 1459. Google Scholar 24. : Enzalutamide with standard first-line therapy in metastatic prostate cancer. N Engl J Med 2019; 381: 121. Google Scholar 25. : Apalutamide for metastatic, castration-sensitive prostate cancer. N Engl J Med 2019; 381: 13. Google Scholar 26. : Addition of docetaxel to hormonal therapy in low- and high-burden metastatic hormone sensitive prostate cancer: long-term survival results from the STAMPEDE trial. Ann Oncol 2019; 30: 1992. Google Scholar 27. : The impact of 68Ga-PSMA PET/CT on management intent in prostate cancer: results of an Australian prospective multicenter study. J Nucl Med 2018; 59: 82. Google Scholar 28. : Impact of 68Ga-PSMA PET on the management of patients with prostate cancer: a systematic review and meta-analysis. Eur Urol 2018; 74: 179. Google Scholar 29. : Timing of radiotherapy after radical prostatectomy (RADICALS-RT): a randomised, controlled phase 3 trial. Lancet 2020; 396: 1413. Google Scholar 30. : Adjuvant radiotherapy versus early salvage radiotherapy following radical prostatectomy (TROG 08.03/ANZUP RAVES): a randomised, controlled, phase 3, non-inferiority trial. Lancet Oncol 2020; 21: 1331. Google Scholar © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByBudäus L and Maurer T (2021) Editorial CommentJournal of Urology, VOL. 205, NO. 6, (1661-1662), Online publication date: 1-Jun-2021. Volume 205Issue 6June 2021Page: 1663-1670Supplementary Materials Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordsprostatic neoplasmsneoplasm staginglymph node dissectionprostatectomypositron emission tomograpyMetricsAuthor Information Thomas Amiel Department of Urology, Technical University of Munich, Munich, Germany Equal study contribution. More articles by this author Christoph Würnschimmel Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada Equal study contribution. More articles by this author Matthias Heck Department of Urology, Technical University of Munich, Munich, Germany More articles by this author Thomas Horn Department of Urology, Technical University of Munich, Munich, Germany More articles by this author Noemi Nguyen Department of Urology, Technical University of Munich, Munich, Germany More articles by this author Lars Budäus Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany More articles by this author Sophie Knipper Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany More articles by this author Mike Wenzel Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany More articles by this author Isabel Rauscher Department of Nuclear Medicine, Technical University of Munich, Munich, Germany Supported by grants from the National Institutes of Health, Howard Hughes Medical Institute, Wellcome Trust and Research Councils UK. More articles by this author Matthias Eiber Department of Nuclear Medicine, Technical University of Munich, Munich, Germany More articles by this author Hui Wang Department of Nuclear Medicine, Technical University of Munich, Munich, Germany Equal study contribution. More articles by this author Tobias Maurer Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany §Correspondence: Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246Hamburg, Germany telephone: +49 (0)40 7410-51300; FAX: +49 (0)40 7410-51323; E-mail Address: [email protected] Equal study contribution. More articles by this author Expand All Advertisement PDF DownloadLoading ..." @default.
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