Despite negative preoperative conventional imaging, up to 10% of patients with prostate cancer (PCa) harbor lymph-node involvement (LNI) at radical prostatectomy (RP). The advent of more accurate imaging modalities such as PET/CT improved the detection of LNI. However, their clinical impact and prognostic value are still unclear. We aimed to investigate the prognostic value of preoperative PET/CT in patients node positive (pN+) at RP.
We retrospectively identified cN0M0 patients at conventional imaging (CT and/or MRI, and bone scan) who had pN+ PCa at RP at 17 referral centers. Patients with cN+ at PSMA/Choline PET/CT but cN0M0 at conventional imaging were also included. Systemic progression/recurrence was the primary outcome; Cox proportional hazards models were used for multivariate analysis.
We included 1163 pN+ men out of whom 95 and 100 had preoperative PSMA and/or Choline PET/CT, respectively. ISUP grade ≥4 was detected in 66.6%. Overall, 42% of patients had postoperative PSA persistence (≥0.1 ng/mL). Postoperative management included initial observation (34%), ADT (22.7%) and adjuvant RT+/-ADT (42.8%). Median follow-up was 42 months. Patients with cN+ on PSMA PET/CT had an increased risk of systemic progression (52.9% vs. 13.6% cN0 PSMA PET/CT vs. 21.5% cN0 at conventional imaging; P < .01). This held true at multivariable analysis: (HR 6.184, 95% CI: 3.386-11-295; P < .001) whilst no significant results were highlighted for Choline PET/CT. No significant associations for both PET types were found for local progression, BCR, and overall mortality (all P > .05). Observation as an initial management strategy instead of adjuvant treatments was related with an increased risk of metastases (HR 1.808; 95% CI: 1.069-3.058; P < .05).
PSMA PET/CT cN+ patients with negative conventional imaging have an increased risk of systemic progression after RP compared to their counterparts with cN0M0 disease both at conventional and/or molecular imaging.
Clinical genitourinary cancer. 2023 Nov 17 [Epub ahead of print]
Giancarlo Marra, Pawel Rajwa, Claudia Filippini, Guillaume Ploussard, Gabriele Montefusco, Ignacio Puche-Sanz, Jonathan Olivier, Fabio Zattoni, Fabrizio Dal Moro, Alessandro Magli, Charles Dariane, Andres Affentranger, Josias Bastian Grogg, Thomas Hermanns, Peter K Chiu, Bartosz Malkiewicz, Kamil Kowalczyk, Roderick C N Van den Bergh, Shahrokh F Shariat, Alberto Bianchi, Alessandro Antonelli, Sebastian Gallina, William Berchiche, Rafael Sanchez-Salas, Xavier Cathelineau, Luca Afferi, Christian Daniel Fankhauser, Agostino Mattei, Robert Jeffrey Karnes, Simone Scuderi, Francesco Montorsi, Alberto Briganti, Désirée Deandreis, Paolo Gontero, Giorgio Gandaglia, EAU-Young Academic Urologists (YAU) Prostate Cancer Working Party (PCa-WP)
Division of Urology, Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy. Electronic address: ., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Medical University of Silesia, Zabrze, Poland., Division of Urology, Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy., Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France., Department of Urology, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain., Department of Urology, Lille University, Lille, France., Department of Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy., Dipartimento di Radioterapia Oncologica, Ospedale Santa Maria della misericordia, Udine, Italia., Department of Urology, Hôpital européen Georges-Pompidou, Université de Paris, Paris, France., University of Zurich, Zurich, Switzerland., Division of Urology, Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong., Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology Wroclaw Medical University, Wroclaw, Poland., Department of Urology, St. Antonius Hospital, Utrecht, The Netherlands., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy., Department of Urology, Institut Mutualiste Montsouris, Paris, France., Department of Surgery, Division of Urology, McGill University, Montreal, Quebec, Canada., Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland., Department of Urology, Mayo Clinic, Rochester, NY., Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy., Division of Nuclear Medicine, Department of Medical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy.