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Preoperative PSMA-PET/CT as a predictor of biochemical persistence and early recurrence following radical prostatectomy with lymph node dissection

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  • Clinical Research
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Abstract

Background

This study aims to evaluate the predictive value of lymph nodes (LN) suspicious for metastases on preoperative prostate-specific membrane antigen (PSMA) PET/CT for biochemical persistence (BCP) and early biochemical recurrence (BCR) following robotic-assisted radical prostatectomy (RARP) with extended pelvic LN dissection (ePLND).

Methods

We evaluated 213 patients with intermediate and high-risk prostate cancer (PCa) who underwent clinical staging with preoperative 68Ga- or 18F-PSMA-PET/CT scan and subsequent RARP with ePLND. Patients were grouped as PSMA− or PSMA+ depending on their LN status on PSMA-PET/CT and subdivided according to histological LN status in pN0 or pN1. Diagnostic accuracy of PSMA-PET/CT for the detection of pN1 was evaluated. BCP was defined as a first postoperative serum PSA level ≥0.1 ng/mL 6–12 weeks following RP. Early BCR was defined as detectable PSA > 0.2 ng/mL within 12 months of follow-up. Univariable logistic regression analyses were used to evaluate the effect of PSMA+ on BCP and BCR.

Results

Forty patients (19%) were PSMA+. The overall incidence of pN1 was 23%. Sensitivity, specificity, PPV and NPV on a per patient level for the detection of pN1 was 29%, 84%, 35%, and 80% respectively. BCP was observed in 26 of 211 patients (12%) and early BCR in 23 of 110 patients (21%). The presence of PSMA+ was a significant predictor for BCP (OR 7.1, 2.9–17.1 95% CI) and BCR (OR 8.1, 2.9–22.6 95% CI).

Conclusion

Preoperative PSMA-PET/CT may be a valuable tool for patient counseling for RARP and ePLND as it is a significant predictor for the risk of postoperative BCP and early BCR. We conclude that an ePLND should not be avoided in men with intermediate or high-risk PCa and preoperative negative PSMA-PET/CT, as 20% have microscopic LN metastasis.

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Fig. 1: Flowchart of selection of patients.
Fig. 2: Biochemical persistence and biochemical recurrence after RARP.

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References

  1. Mottet N, van den Bergh RCN, Briers E, Cornford P, de Santis M, Fanti S, et al. EAU–ESTRO–ESUR–SIOG Guidelines on Prostate Cancer 2020. In: European Association of Urology Guidelines 2020 Edition. Arnhem, The Netherlands: European Association of Urology Guidelines Office; 2020. http://uroweb.org/guideline/prostate-cancer/%7C.

  2. Ventimiglia E, Seisen T, Abdollah F, Briganti A, Fonteyne V, James N, et al. A systematic review of the role of definitive local treatment in patients with clinically lymph node-positive prostate cancer. vol. 2, European Urology Oncology. Elsevier B.V.; 2019. p. 294–301. https://pubmed.ncbi.nlm.nih.gov/31200844/.

  3. Ware RE, Williams S, Hicks RJ. Molecular imaging of recurrent and metastatic prostate cancer. 49, Seminars in Nuclear Medicine. W.B. Saunders; 2019. p. 280–93. https://pubmed.ncbi.nlm.nih.gov/31227051/.

  4. Lenis AT, Pooli A, Lec PM, Sadun TY, Johnson DC, Lebacle C, et al. Prostate-specific membrane antigen positron emission tomography/computed tomography compared with conventional imaging for initial staging of treatment-naïve intermediate- and high-risk prostate cancer: a retrospective single-center study. Eur Urol Oncol. 2020. https://doi.org/10.1016/j.euo.2020.08.012.

  5. Hofman MS, Lawrentschuk N, Francis RJ, Tang C, Vela I, Thomas P, et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. The Lancet. 2020;395. https://doi.org/10.1016/S0140-6736(20)30314-7.

  6. Hope TA, Armstrong WR, Murthy V, Lawhn Heath C, Behr S, Barbato F, et al. Accuracy of 68Ga-PSMA-11 for pelvic nodal metastasis detection prior to radical prostatectomy and pelvic lymph node dissection: a multicenter prospective phase III imaging study. J Clin Oncol. 2020;38 15_suppl:5502.

    Article  Google Scholar 

  7. Cagiannos I, Karakiewicz P, Eastham JA, Ohori M, Rabbani F, Gerigk C, et al. A preoperative nomogram identifying decreased risk of positive pelvic lymph nodes in patients with prostate cancer. J Urol. 2003;170:1798–803. https://pubmed.ncbi.nlm.nih.gov/14532779/.

  8. Hövels AM, Heesakkers RAM, Adang EM, Jager GJ, Strum S, Hoogeveen YL, et al. The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol. 2008;63:387–95. https://pubmed.ncbi.nlm.nih.gov/18325358/.

  9. Fossati N, Willemse PPM, van den Broeck T, van den Bergh RCN, Yuan CY, Briers E, et al. The benefits and harms of different extents of lymph node dissection during radical prostatectomy for prostate cancer: a systematic review. 72, European Urology. Elsevier B.V.; 2017. p. 84–109. https://pubmed.ncbi.nlm.nih.gov/28126351/.

  10. Freedland SJ, Humphreys EB, Mangold LA, Eisenberger M, Dorey FJ, Walsh PC, et al. Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. J Am Med Assoc. 2005;294:433–9. https://pubmed.ncbi.nlm.nih.gov/16046649/.

  11. Sengupta S, Christensen CM, Zincke H, Slezak JM, Leibovich BC, Bergstralh EJ, et al. Detectable prostate specific antigen between 60 and 120 days following radical prostatectomy for prostate cancer: natural history and prognostic significance. J Urol. 2006;176:559–63. https://pubmed.ncbi.nlm.nih.gov/16813889/.

  12. Rogers CG, Khan MA, Miller MC, Veltri RW, Partin AW. Natural history of disease progression in patients who fail to achieve an undetectable prostate-specific antigen level after undergoing radical prostatectomy. Cancer. 2004;101:2549–56. https://pubmed.ncbi.nlm.nih.gov/15470681/.

  13. Haese A, Huland E, Graefen M, Hammerer P, Noldus J, Huland H. Ultrasensitive detection of prostate specific antigen the followup of 422 patients after radical prostatectomy. J Urol. 1999;161:1206–11.

    Article  CAS  PubMed  Google Scholar 

  14. Viney R, Gommersall L, Zelf J, Hayne D, Shah ZH, Doherty A. Ultrasensitive prostate specific antigen assay following laparoscopic radical prostatectomy—an outcome measure for defining the learning curve. Ann R Coll Surg Engl. 2009;91:399–403. https://pubmed.ncbi.nlm.nih.gov/19409146/.

  15. Stephenson AJ, Scardino PT, Eastham JA, Bianco FJ, Dotan ZA, Fearn PA, et al. Preoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy. J Natl Cancer Inst. 2006;98:715–7. https://pubmed.ncbi.nlm.nih.gov/16705126/.

  16. Graefen M, Karakiewicz PI, Cagiannos I, Quinn DI, Henshall SM, Grygiel JJ, et al. International validation of a preoperative nomogram for prostate cancer recurrence after radical prostatectomy. J Clin Oncol. 2002;20:3206–12. https://pubmed.ncbi.nlm.nih.gov/12149292/.

  17. Koschel S, Murphy DG, Hofman MS, Wong LM. The role of prostate-specific membrane antigen PET/computed tomography in primary staging of prostate cancer. 29, Current Opinion in Urology. Lippincott Williams and Wilkins; 2019. p. 569–77. https://pubmed.ncbi.nlm.nih.gov/31567440/.

  18. van Kalmthout LWM, van Melick HHE, Lavalaye J, Meijer RP, Kooistra A, de Klerk JMH, et al. Prospective validation of Gallium-68 prostate specific membrane antigen-positron emission tomography/computerized tomography for primary staging of prostate cancer. J Urol. 2020;203:537–45. https://pubmed.ncbi.nlm.nih.gov/31487220/.

  19. Jansen BHE, Bodar YJL, Zwezerijnen GJC, Meijer D, van der Voorn JP, Nieuwenhuijzen JA, et al. Pelvic lymph-node staging with 18F-DCFPyL PET/CT prior to extended pelvic lymph-node dissection in primary prostate cancer—the SALT trial. Eur J Nucl Med Mol Imag. 2021;48:509–20. https://pubmed.ncbi.nlm.nih.gov/32789599/.

  20. Pienta KJ, Gorin MA, Rowe SP, Carroll PR, Pouliot F, Probst S, et al. A phase 2/3 prospective multicenter study of the diagnostic accuracy of prostate-specific membrane antigen PET/CT with 18 F-DCFPyL in Prostate Cancer Patients (OSPREY). J Urol. 2021. https://doi.org/10.1097/JU.0000000000001698.

  21. Zhang Q, Zang S, Zhang C, Fu Y, Lv X, Zhang Q, et al. Comparison of 68Ga-PSMA-11 PET-CT with mpMRI for preoperative lymph node staging in patients with intermediate to high-risk prostate cancer. J Transl Med. 2017;15. https://doi.org/10.1186/s12967-017-1333-2.

  22. Budäus L, Leyh-Bannurah SR, Salomon G, Michl U, Heinzer H, Huland H, et al. Initial experience of 68Ga-PSMA PET/CT imaging in high-risk prostate cancer patients prior to radical prostatectomy. Eur Urol. 2016;69:393–6.

    Article  PubMed  Google Scholar 

  23. van Leeuwen PJ, Emmett L, Ho B, Delprado W, Ting F, Nguyen Q, et al. Prospective evaluation of 68Gallium-prostate-specific membrane antigen positron emission tomography/computed tomography for preoperative lymph node staging in prostate cancer. BJU Int. 2017;119:209–15.

    Article  PubMed  Google Scholar 

  24. Yaxley JW, Raveenthiran S, Nouhaud FX, Samartunga H, Yaxley AJ, Coughlin G, et al. Outcomes of primary lymph node staging of intermediate and high risk prostate cancer with 68Ga-PSMA positron emission tomography/computerized tomography compared to histological correlation of pelvic lymph node pathology. J Urol. 2019;201:815–20.

    Article  PubMed  Google Scholar 

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Author information

Author notes

  1. These authors contributed equally: D. J. H. Baas, M. Schilham.

  2. These authors jointly supervised this work: J. P. van Basten, D. M. Somford.

Authors and Affiliations

  1. Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands

    D. J. H. Baas, J. M. S. de Baaij, R. J. Hoekstra, J. P. van Basten & D. M. Somford

  2. Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands

    D. J. H. Baas, M. Schilham, J. M. S. de Baaij, H. J. E. J. Vrijhof, R. J. Hoekstra, J. P. M. Sedelaar, J. P. van Basten & D. M. Somford

  3. Department of Medical Imaging, Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands

    M. Schilham & M. Gotthardt

  4. Department of Nuclear Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands

    R. Hermsen

  5. Department of Urology, Catharina Hospital, Eindhoven, The Netherlands

    H. J. E. J. Vrijhof & R. J. Hoekstra

  6. Department of Urology, Radboudumc, Nijmegen, The Netherlands

    J. P. M. Sedelaar

  7. Department of Pathology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands

    H. V. N. Küsters-Vandevelde

  8. CWZ Academy, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands

    C. H. W. Wijers

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Contributions

Conception and design: DB, MS, and DS. Collection and assembly of data: DB, JdB, and MS. Data analysis and interpretation: DB, MS, CW, JvB, and DS. Initial paper writing: DB and MS. Critical review and final approval of paper: all authors.

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Correspondence to D. J. H. Baas.

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Baas, D.J.H., Schilham, M., Hermsen, R. et al. Preoperative PSMA-PET/CT as a predictor of biochemical persistence and early recurrence following radical prostatectomy with lymph node dissection. Prostate Cancer Prostatic Dis 25, 65–70 (2022). https://doi.org/10.1038/s41391-021-00452-y

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