The distribution of prostate cancer recurrences on 68 Ga-PSMA PET/CT after radical prostatectomy with pathological node positive extended lymph node dissection.

To examine the anatomical distribution of prostate cancer (PCa) recurrence on 68 Ga-PSMA PET/CT in patients with biochemical recurrence (BCR) after radical prostatectomy (RP) with pathologically lymph node metastasis (pN1) in their extended pelvic lymph node dissection (ePLND). Furthermore, to compare the location of PCa recurrence with the location of the initial lymph node metastasis at ePLND.

We retrospectively included 100 patients with BCR (PSA 0.05 - 5.00 ng/ml) after RP with pN1 ePLND who underwent 68 Ga-PSMA-PET/CT to guide salvage therapy. Clinical and pathological features, and anatomical locations of PCa recurrence on 68 Ga-PSMA PET/CT were obtained. Also management impact was recorded.

68(68%) patients had a positive, and 32(32%) patients had a negative 68 Ga-PSMA-PET/CT. Of the 68 patients with a positive 68 Ga-PSMA PET/CT, 44(65%) patients showed abnormal uptake only in the pelvic area, 7 (10%) patients only outside the pelvic area, and 17(25%) patients both in- and outside the pelvic area. 68 Ga-PSMA PET/CT positive pelvic lymph nodes were often (84%) detected at the identical side of the lymph node metastasis diagnosed at ePLND. According to the outcomes of the 68 Ga-PSMA-PET/CT, change of management was noted in 68% of the patients.

PCa recurrence on 68 Ga-PSMA PET/CT was limited to the pelvis in the majority of patients with BCR after RP with pN1 ePLND. Moreover, recurrence was often detected at the identical side as the lymph node metastasis at ePLND. The results confirm the diagnostic value of 68 Ga-PSMA PET/CT in patients with BCR after RP with pN1 ePLND. Prospective studies are needed to support the long-term benefit of 68 Ga-PSMA PET/CT dictated management changes.

BJU international. 2020 Mar 17 [Epub ahead of print]

Thijs H Huits, Henk B Luiting, Henk van der Poel, Rohan Nandurkar, Maarten Donswijk, Eva Schaake, Wouter Vogel, Monique J Roobol, Esther Wit, Phillip Stricker, Louise Emmett, Pim J van Leeuwen

Department of Urology, The Netherlands Cancer Institute, the Netherlands., Department of Urology, Erasmus Medical Centre, the Netherlands., St Vincent's Hospital Nuclear Medicine, PET Department, Darlinghurst, NSW, Australia., Department of Nuclear Medicine, The Netherlands Cancer Institute, the Netherlands., Department of Radiation Oncology, The Netherlands Cancer Institute, the Netherlands., St. Vincent's Prostate Cancer Centre, Darlinghurst, New South Wales, Australia.