Preoperative 68Ga-PSMA PET/CT defines a subgroup of high-risk prostate cancer patients with favorable outcomes after radical prostatectomy and lymph node dissection

• Published in: Prostate cancer and prostatic diseases 2021-09, Vol.24 (3), p.910-916
• Main Authors: Dekalo, Snir, Kuten, Jonathan, Mintz, Ishai, Fahoum, Ibrahim, Gitstein, Gilad, Keizman, Daniel, Sarid, David, Matzkin, Haim, Mabjeesh, Nicola J., Beri, Avi, Even-Sapir, Einat, Yossepowitch, Ofer, Mano, Roy
• Format: Article
• Language: English
• Subjects: 59/78; 692/699/67/1059; 692/699/67/589/466; Adjuvant treatment; Aged; Biochemistry; Biomedical and Life Sciences; Biomedicine; Cancer; Cancer patients; Cancer Research; Cancer surgery; Care and treatment; Computed tomography; Follow-Up Studies; Gallium Isotopes - metabolism; Gallium Radioisotopes - metabolism; Health risks; Humans; Lymph Node Excision - mortality; Lymph nodes; Lymphatic system; Male; Medical imaging; Middle Aged; Neoplasm Recurrence, Local - diagnostic imaging; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Patient outcomes; Patients; PET imaging; Positron emission; Positron Emission Tomography Computed Tomography - methods; Preoperative Care; Prognosis; Prostate cancer; Prostatectomy; Prostatectomy - mortality; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - mortality; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Radiopharmaceuticals - metabolism; Regression analysis; Regression models; Reproductive Medicine; Retrospective Studies; Risk; Risk factors; Subgroups; Surgery; Survival; Survival Rate; Tomography; Urological surgery
• ISSN: 1365-7852; 1476-5608
• DOI: 10.1038/s41391-021-00347-y

Background High-risk prostate cancer is associated with adverse pathology and unfavorable outcomes after radical prostatectomy. 68 Ga-PSMA PET/CT is more accurate than conventional imaging for preoperative staging. We aimed to evaluate whether lymph node involvement on 68 Ga-PSMA PET/CT prior to radical prostatectomy in patients with high-risk prostate cancer is associated with worse short-term oncologic outcomes. Methods We retrospectively reviewed 149 patients with high-risk localized or locoregional prostate cancer who underwent 68 Ga-PSMA PET/CT prior to radical prostatectomy between 2015 and 2020. None of the patients received neoadjuvant or adjuvant treatment. The study endpoints were PSA persistence and biochemical recurrence. Logistic regression models were used to identify preoperative predictors of PSA persistence. Kaplan–Meier analyses were used to estimate biochemical recurrence-free survival. Results Of 149 identified patients, 19 (13%) were found to have lymph node involvement on preoperative 68 Ga-PSMA PET/CT. The sensitivity, specificity, and accuracy of 68 Ga-PSMA PET/CT for identifying pathologic lymph node involvement were 68%, 95%, and 92%, respectively. PSA persistence rate was lower among patients with PET-negative lymph nodes than those with PET-positive nodes (15 vs. 84%, p