(UroToday.com) The 2024 American Urological Association (AUA) annual meeting held in San Antonio, TX between May 3 and May 6, 2024, was host to the prostate cancer staging session. Dr. Felix Preisser presented the results of a retrospective cohort of patients with prostate cancer who had undergone radical prostatectomy and had a PSMA PET/CT prior to surgery. Their main objective was to report the descriptive tumor characteristics of patients with miN0M0 disease compared to miM1 +/- miN1 and of miN1 disease.
Dr. Preisser started by discussing that PSMA PET/CT molecular imaging (mi) exhibits high specificity and sensitivity for the initial staging of prostate cancer patients. This imaging modality has been endorsed and recommended for high-risk prostate cancer by the European Association of Urology (EAU) guidelines, as well as the National Comprehensive Cancer Network (NCCN) guidelines.
They identified patients who had a PSMA PET/CT prior to radical prostatectomy between 2016 and 2021 within a high-volume center in Europe. This study included 922 patients who had a preoperative PSMA PET/CT. A total of 802 (80.8%) patients had miN0M0, 112 (11.3%) had miN1, and 78 (7.9%) had miM1 disease. Among the miM1 patients, 20 had miM1a and 50 had miM1b disease. Of the PET scans, 765 were conducted with Ga-68 and 227 with 18-F. In patients who had not received neoadjuvant androgen deprivation therapy, the median PSA prior to radical prostatectomy was 12.5 ng/mL for miM1 compared to 9.0 ng/mL for miN0M0 (p=0.02).
miM1 patients more frequently harbored D’Amico high-risk criteria (75% and vs. 43.6%, p<0.001), locally advanced disease as pathologic stage ≥T3b (66.1% vs. 21.8%, p<0.001) and pathologic ISUP grade 4-5 in the prostatectomy specimen (44.6% vs. 13.3%, p<0.001) compared to miN0M0 patients.
Similarly to miM1 patients, miN1 patients more frequently harbored D’Amico high-risk criteria (p<0.001), pathologic stage ≥T3b (p<0.001) and pathologic ISUP grade 4-5 in the prostatectomy specimen (p<0.001) compared to miN0M0 patients. However, unlike in miM1 patients, the median PSA prior to RP (12.5 ng/ml vs. 9 ng/ml, p=0.02) compared to miN0M0 patients was significantly higher.
Dr. Preisser concluded his talk by highlighting that miM1 and miN1 prostate cancer patients detected in PSMA PET/CT harbor more unfavorable pathologic characteristics compared to miM0 miN0 patients during radical prostatectomy.
Presented by: Felix Preisser, MD, Researcher, Department of Urology, Universität Hamburg-Eppendorf, Hamburg, Germany
Written by: Julian Chavarriaga, MD - Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @chavarriagaj on Twitter during the 2024 American Urological Association (AUA) annual meeting held in San Antonio, TX between May 3rd and May 6th, 2024