The Prognostic Role of Preoperative PSMA PET/CT in cN0M0 pN+ Prostate Cancer: A Multicenter Study

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.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.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).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.

Авторы
Marra Giancarlo 1 , Rajwa Pawel 2, 3, 4 , Filippini Claudia 1 , Ploussard Guillaume 5 , Montefusco Gabriele 1 , Puche-Sanz Ignacio 6 , Olivier Jonathan 7 , Zattoni Fabio 8 , Moro F.D. 8 , Magli Alessandro 9 , Dariane Charles 10 , Affentranger Andres 11 , Grogg J.B. 11 , Hermanns Thomas 11 , Chiu P.K. 12 , Malkiewicz Bartosz 13 , Kowalczyk Kamil 13 , Van Den Bergh R.C. 14 , Shariat S.F. 2, 3 , Bianchi Alberto 15 , Antonelli Alessandro 15 , Gallina Sebastian 15 , Berchiche William 16 , Sanchez-Salas Rafael 17 , Cathelineau Xavier 16 , Afferi Luca 18 , Fankhauser C.D. 18 , Mattei Agostino 18 , Karnes R.J. 19 , Scuderi Simone 20, 21 , Montorsi Francesco 20, 21 , Briganti Alberto 20, 21 , Deandreis Désirée 22 , Gontero Paolo 1 , Gandaglia Giorgio 20, 21 , Matteo Facco 8 , Tonetto Fabrizio 9 , Soeterik Timo 14
Журнал
Clinical Genitourinary Cancer
Издательство
Cancer Information Group
Номер выпуска
2
Язык
Английский
Страницы
244-251
Статус
Опубликовано
Том
22
Год
2024
Организации
  • 1 Division of Urology, Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy
  • 2 Department of Urology
  • 3 Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  • 4 Medical University of Silesia, Zabrze, Poland
  • 5 Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France
  • 6 Department of Urology, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
  • 7 Department of urology, Lille university, CHU Lille, Lille, France
  • 8 Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
  • 9 Dipartimento di radioterapia oncologica, Ospedale Santa Maria della misericordia, Udine, Italia
  • 10 Department of urology, Hôpital européen Georges-Pompidou, Université de Paris
  • 11 University of Zurich, Zurich, Switzerland
  • 12 SH Ho Urology Centre, Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  • 13 Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology Wroclaw Medical University, Poland
  • 14 Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
  • 15 Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
  • 16 Department of Urology, Institut Mutualiste Montsouris, Paris, France
  • 17 Department of Surgery, Division of Urology, McGill University, Montreal, Quebec, Canada
  • 18 Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
  • 19 Department of Urology, Mayo Clinic, Rochester, US
  • 20 Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
  • 21 Vita-Salute San Raffaele University, Milan, Italy.
  • 22 Division of Nuclear Medicine, Department of Medical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy
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Монография
Аватков В.А., Апанович М.Ю., Борзова А.Ю., Бордачев Т.В., Винокуров В.И., Волохов В.И., Воробьев С.В., Гуменский А.В., Иванченко В.С., Каширина Т.В., Матвеев О.В., Окунев И.Ю., Поплетеева Г.А., Сапронова М.А., Свешникова Ю.В., Фененко А.В., Феофанов К.А., Цветов П.Ю., Школярская Т.И., Штоль В.В. ...
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