Prostate-specific membrane antigen radioguided surgery with negative histopathology
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Prostate-specific membrane antigen radioguided surgery with negative histopathology. / Koehler, Daniel; Trappe, Samuel; Shenas, Farzad; Karimzadeh, Amir; Apostolova, Ivayla; Klutmann, Susanne; Ambrosini, Francesca; Budäus, Lars; Falkenbach, Fabian; Knipper, Sophie; Maurer, Tobias.
in: EUR J NUCL MED MOL I, Jahrgang 51, Nr. 2, 01.2024, S. 548-557.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Prostate-specific membrane antigen radioguided surgery with negative histopathology
AU - Koehler, Daniel
AU - Trappe, Samuel
AU - Shenas, Farzad
AU - Karimzadeh, Amir
AU - Apostolova, Ivayla
AU - Klutmann, Susanne
AU - Ambrosini, Francesca
AU - Budäus, Lars
AU - Falkenbach, Fabian
AU - Knipper, Sophie
AU - Maurer, Tobias
N1 - © 2023. The Author(s).
PY - 2024/1
Y1 - 2024/1
N2 - PURPOSE: To identify reasons for negative histopathology of specimens from prostate-specific membrane antigen (PSMA) radioguided surgery (PSMA-RGS) in recurrent prostate cancer (PCa) after prostatectomy.METHODS: Of 302 patients who underwent PSMA-RGS, 17 (5.6%) demonstrated a negative histopathology. Preoperative data, PSMA PET, PSMA SPECT, and follow-up information were analyzed retrospectively to differentiate true/false positive (TP/FP) from true/false negative (TN/FN) lesions.RESULTS: The median prostate-specific antigen at PET was 0.4 ng/ml (interquartile range [IQR] 0.3-1.2). Twenty-five index lesions (median short axis 7 mm, IQR 5-8; median long-axis 12 mm, IQR 8-17) had a median SUVmax of 4 (IQR 2.6-6; median PSMA expression score 1, IQR 1-1). Six lesions were TP, twelve were FP, one was TN, and six remained unclear. All TP lesions were in the prostatic fossa or adjacent to the internal iliac arteries. Three suspected local recurrences were FP. All FP lymph nodes were located at the distal external iliac arteries or outside the pelvis. A low PSMA-expressing TN node was identified next to a common iliac artery. Unclear lesions were located next to the external iliac arteries or outside the pelvis.CONCLUSION: In most cases with a negative histopathology from PSMA-RGS, lesions were FP on PSMA PET. Unspecific uptake should be considered in low PSMA-expressing lymph nodes at the distal external iliac arteries or outside the pelvis, especially if no PSMA-positive lymph nodes closer to the prostatic fossa are evident. Rarely, true positive metastases were missed by surgery or histopathology.
AB - PURPOSE: To identify reasons for negative histopathology of specimens from prostate-specific membrane antigen (PSMA) radioguided surgery (PSMA-RGS) in recurrent prostate cancer (PCa) after prostatectomy.METHODS: Of 302 patients who underwent PSMA-RGS, 17 (5.6%) demonstrated a negative histopathology. Preoperative data, PSMA PET, PSMA SPECT, and follow-up information were analyzed retrospectively to differentiate true/false positive (TP/FP) from true/false negative (TN/FN) lesions.RESULTS: The median prostate-specific antigen at PET was 0.4 ng/ml (interquartile range [IQR] 0.3-1.2). Twenty-five index lesions (median short axis 7 mm, IQR 5-8; median long-axis 12 mm, IQR 8-17) had a median SUVmax of 4 (IQR 2.6-6; median PSMA expression score 1, IQR 1-1). Six lesions were TP, twelve were FP, one was TN, and six remained unclear. All TP lesions were in the prostatic fossa or adjacent to the internal iliac arteries. Three suspected local recurrences were FP. All FP lymph nodes were located at the distal external iliac arteries or outside the pelvis. A low PSMA-expressing TN node was identified next to a common iliac artery. Unclear lesions were located next to the external iliac arteries or outside the pelvis.CONCLUSION: In most cases with a negative histopathology from PSMA-RGS, lesions were FP on PSMA PET. Unspecific uptake should be considered in low PSMA-expressing lymph nodes at the distal external iliac arteries or outside the pelvis, especially if no PSMA-positive lymph nodes closer to the prostatic fossa are evident. Rarely, true positive metastases were missed by surgery or histopathology.
KW - Male
KW - Humans
KW - Retrospective Studies
KW - Prostate/diagnostic imaging
KW - Neoplasm Recurrence, Local/diagnostic imaging
KW - Prostate-Specific Antigen/metabolism
KW - Prostatic Neoplasms/diagnostic imaging
KW - Surgery, Computer-Assisted/methods
KW - Gallium Radioisotopes
KW - Positron Emission Tomography Computed Tomography/methods
KW - Prostatectomy/methods
U2 - 10.1007/s00259-023-06442-7
DO - 10.1007/s00259-023-06442-7
M3 - SCORING: Journal article
C2 - 37750908
VL - 51
SP - 548
EP - 557
JO - EUR J NUCL MED MOL I
JF - EUR J NUCL MED MOL I
SN - 1619-7070
IS - 2
ER -
