(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 podium session. Dr. Sanjay Kumar presented the results of a prospective comparative study of patients with intermediate or high-risk prostate cancer who were potential candidates for radical prostatectomy (RP) and were staged with 68Ga-PSMA PET/CT and multiparametric MRI (mpMRI) prior to surgery. PET/CT and mpMRI were compared to test their accuracy in determining lymph node involvement.
Dr. Kumar began his presentation by highlighting that pelvic lymph node dissection (PLND) provides the most accurate staging information, but conflicting data exist regarding its benefit on survival outcomes. Currently, PLND is primarily performed for intermediate and high-risk prostate cancer based on risk assessment using various lymph node involvement prediction tools. However, PLND is not without complications, and complications such as deep vein thrombosis, pulmonary embolism, and vascular, and nerve injury could arise from this procedure. The aim of this study was to compare 68-Ga-PSMA PET/CT and multiparametric MRI in detecting lymph node metastases in patients who underwent radical prostatectomy (RP).
The study prospectively enrolled 92 prostate cancer patients, who were potential candidates for radical prostatectomy. Among these, 57 had intermediate-risk and 35 had high-risk disease. All patients underwent RP and PLND, and the performance of both 68Ga-PSMA PET/CT and mpMRI was compared to the gold standard, which was the final pathology. The mean PSA was 23.01 ng/mL, and other clinical characteristics are presented in Table 1.
Of the 92 patients who underwent surgery, final pathology confirmed regional lymph node involvement in 8 patients (8.6%). Among these, ⁶⁸Ga-PSMA-PET/CT was positive for 7 (87.5%), while mpMRI was positive for 2 (25%).
Dr. Kumar demonstrated that 68Ga-PSMA PET/CT exhibited higher sensitivity (87.5%), specificity (97.6%), negative predictive value (NPV) (98.8%), positive predictive value (PPV) (77.8%), and accuracy (96.70%) compared to mpMRI for the detection of lymph node metastasis (Figure below).
Dr Kumar wrapped up his presentation stating that the results of their study indicate that 68Ga-PSMA PET/CT surpasses mpMRI in detecting lymph node metastasis in patients with intermediate and high-risk prostate cancer who are undergoing surgery.
Presented by: Sanjay Kumar MD, Associate Professor of Urology, AIIMS, New Delhi, India
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