AUA 2017: PSMA PET/CT Improves Biochemical Response after Salvage Lymph Node Dissection for Nodal Recurrence in Prostate Cancer Patients

Boston, MA ( Salvage pelvic lymph node dissection (sPLND) upon indication by biochemical recurrence (BCR) represents a second opportunity for curative treatment for metastatic prostate cancer. While previous methods of imaging (i.e. 11-Choline PET/CT and Bone Scan) required rising PSA levels > 5 ng/mL for the detection of local metastases, recent developments in the 68-Gallium Prostate Specific Membrane Antigen (68-Ga-PSMA) shows promise at PSA levels as low as 0.2 ng/mL.

Dr. Annika Herlemann of the University of Munich Germany, presents a robust study comparing the efficacy of 18F-FEC versus 68-Ga PSMA PET/CT in the sPLND setting. 104 sPLND prostate cancer patients diagnosed with lymph node metastases post-RP were enrolled between 2005 and 2016. Post-sPLND efficacy was defined using BCR, clinical recurrence upon subsequent imaging, and prostate-cancer specific mortality (PCSM).

At sPLND, average patient age was 64.7 (SD: 7.0 years), with a rising BCR with average PSA 8.2 ng/mL (SD: 14.8 ng/mL). Mean lymph node yield was 17.1 (SD 15.0) per patient, though only 5.2 (SD 7.4) were positive. Of the 104 patients undergoing sPLND, 29.8% of patients had no evidence of disease at a median follow-up of 45.7 months. While the 18F-FEC PET/CT patients showed comparably results in detecting BCR post-RP, PSA at time of detection was much lower (p=0.048). Overall complication rate of sPLND per Clavien-Dindo Grade III complications was 4.8%.

Overall, the benefit of 68-Ga PSMA PET/CT presents as earlier detection at lower PSA levels, with its attendant impact on oncological control after BCR. Future studies on the benefit of sPLND and its therapeutic benefit are required, particularly within the context of the earlier detection windows offered by 68-Ga PSMA.

Presented By: Annika Herlemann, MD, Ludwig-Maximilians – University of Munich, Germany

Authors: Annika Herlemann, Alexander Kretschmer, Alexander Buchner, Alexander Karl, Stefan Tritschler, Lina El-Malazi, Vera Wenter, Harun Ilhan, Peter Bartenstein, Christian Georg Stief, Christian Gratzke

Written By: Linda Huynh (BS), an assistant research specialist from the University of California, Irvine, on behalf of

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA