(UroToday.com) The 2023 EAU annual meeting included a session on long-term cancer control of prostate cancer, featuring a presentation by Dr. Simone Scuderi discussing the prognostic impact of preoperative PSMA-PET on early oncological outcomes in prostate cancer patients treated with radical prostatectomy. PSMA-PET in prostate cancer staging is associated with higher accuracy for nodal and metastatic detection than conventional imaging. However, clinical guidelines still do not recommend PSMA-PET before radical prostatectomy. As such, Dr. Scuderi and colleagues hypothesized that the implementation of PSMA PET in the preoperative staging pathway is associated with better patient risk stratification and early cancer control.
This study relied on 3,978 N0M0 prostate cancer patients treated with radical prostatectomy +/- extended pelvic nodal dissection between 2010 and 2022. There were 3,518 men staged with conventional imaging identified in a single institution dataset (Group 1). An additional 273 patients with available details both on PSMA PET and CT scans were identified from a multi-institutional cohort of men staged with PSMA-PET (Group 2). Early recurrence was defined as PSA persistence (first postoperative PSA ≥0.1 ng/ml) or PSA ≥0.2 ng/ml within 1 year after radical prostatectomy. Multivariable logistic regression tested the impact of the preoperative imaging on early recurrence. Multivariable logistic regression models tested for predictor status of PET-PSMA and CT-scan after adjusting for PSA, biopsy grade group and non-organ-confined disease at mpMRI. The accuracy of multivariable logistic regression models containing PET-PSMA (model 1) and CT-scan (model 2) were assessed with the ROC-derived AUC. Decision-curve analyses assessed the net benefit associated with the use of the two models.
There were 282 patients that experienced early recurrence. Patients in Group 2 had higher preoperative PSA values (8.5 vs. 6.4 ng/mL) and higher rates of biopsy grade group (GG) >3 (57% vs. 11%, all p <0.01) compared to Group 1. Early BCR rates were similar between the two groups (12% vs. 10% for group 2 and group 1, respectively, p = 0.30). At multivariable logistic regression, being staged with PSMA-PET was associated with a lower risk of early recurrence (OR 0.61, p = 0.01) after accounting for PSA, clinical stage, and biopsy ISUP GG:
Focusing on men with available PSMA-PET and CT (n = 273), the presence of positive PET-PSMA (OR: 4.34, p=0.004) but not CT-scan predicted early recurrence. The discrimination was higher for model 1 including PSMA-PET compared to model 2 (73 vs. 67%). The adoption of model 1 including PSMA-PET was associated with a higher net benefit as compared to model 2.
Dr. Scuderi concluded this presentation discussing the prognostic impact of preoperative PSMA-PET on early oncological outcomes in prostate cancer patients treated with radical prostatectomy with the following take-home messages:
- Non-metastatic prostate cancer patients staged with PSMA PET scan are at lower risk of early recurrence when compared to those staged with conventional imaging alone
- PSMA PET scan helps clinicians to improve preoperative risk stratification and to the identification of men who might benefit most from treatments
Presented by: Simone L.A. Scuderi, MD, Division of Oncology Unit of Urology IRCCS Ospedale San Raffaele Vita-Salute San Raffaele University Milan Italy, Urology, Milan, Italy
Co-Authors: Gandaglia G.2, Mazzone E.2, Huebner N.3, Brunocilla E.4, Dal Moro F.5, Sartorello A.6, Ibanez L.7, Jesús M-S.7, Mattei A.8, Afferi L.8, Shariat S.9, Wolfgang F.10, Picchio M.11, Marra G.12, Zattoni F.5, Reitano G.5, Rajwa P.9, Gomez-Rivas J.7, Kesch C.13, Porpiglia F.14, Amparore D.14, Checcucci E.14, Montorsi F.2, Briganti A.2
Affiliations: 1Division of Oncology Unit of Urology IRCCS Ospedale San Raffaele Vita-Salute San Raffaele University Milan Italy, Urology, Milan, Italy, 2IRCCS Ospedale San Raffaele, VitaSalute San Raffaele University, Dept. of Urology, Milan, Italy, 3Medical University of Vienna, Dept. of Urology, Vienna, Austria, 4Università di Bologna, Dept. of Urology, Bologna, Italy, 5University of Padua, Dept. of Surgery, Oncology and Gastroenterology, Padua, Italy, 6Veneto Institute of Oncology IOV-IRCCS, Nuclear Medicine Unit, Padue, Italy, 7Hospital Clínico San Carlos, Dept. of Urology, Madrid, Spain, 8Klinik für Urologie, Luzerner Kantonsspital, Dept. of Urology, Lucerne, Switzerland, 9Medical University of Vienna, Dept. of Urology, Vienna, Austria, Medical University of Vienna, Dept. of Urology, Vienna, Austria, 10Department of Nuclear Medicine Essen, Dept. of Nuclear Medicine, Essen, Germany, 11IRCCS Ospedale San Raffaele, Dept. of Nuclear Medicine, Milan, Italy, 12Città della Salute e della Scienza, University of Turin, Dept. of Urology, Turin, Italy, 13Essen University Hospital, Dept. of Urology, Essen, Germany, 14Orbassano, Dept. of Urology, Orbassano, Italy
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2023 European Association of Urology (EAU) Annual Meeting, Milan, IT, Fri, Mar 10 – Mon, Mar 13, 2023.