Combining PSA and PET features to select candidates for salvage lymph node dissection in recurrent prostate cancer
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Combining PSA and PET features to select candidates for salvage lymph node dissection in recurrent prostate cancer. / Bravi, Carlo A; Heidenreich, Axel; Fossati, Nicola; Gandaglia, Giorgio; Suardi, Nazareno; Mazzone, Elio; Stabile, Armando; Cucchiara, Vito; Osmonov, Daniar; Juenemann, Klaus-Peter; Karnes, R Jeffrey; Kretschmer, Alexander; Buchner, Alexander; Stief, Christian; Hiester, Andreas; Albers, Peter; Devos, Gaëtan; Joniau, Steven; Van Poppel, Hendrik; Grubmüller, Bernhard; Shariat, Shahrokh; Tilki, Derya; Graefen, Markus; Gill, Inderbir S; Mottrie, Alexander; Karakiewicz, Pierre I; Montorsi, Francesco; Briganti, Alberto; Pfister, David.
In: BJUI compass, Vol. 4, No. 1, 01.2023, p. 123-129.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Combining PSA and PET features to select candidates for salvage lymph node dissection in recurrent prostate cancer
AU - Bravi, Carlo A
AU - Heidenreich, Axel
AU - Fossati, Nicola
AU - Gandaglia, Giorgio
AU - Suardi, Nazareno
AU - Mazzone, Elio
AU - Stabile, Armando
AU - Cucchiara, Vito
AU - Osmonov, Daniar
AU - Juenemann, Klaus-Peter
AU - Karnes, R Jeffrey
AU - Kretschmer, Alexander
AU - Buchner, Alexander
AU - Stief, Christian
AU - Hiester, Andreas
AU - Albers, Peter
AU - Devos, Gaëtan
AU - Joniau, Steven
AU - Van Poppel, Hendrik
AU - Grubmüller, Bernhard
AU - Shariat, Shahrokh
AU - Tilki, Derya
AU - Graefen, Markus
AU - Gill, Inderbir S
AU - Mottrie, Alexander
AU - Karakiewicz, Pierre I
AU - Montorsi, Francesco
AU - Briganti, Alberto
AU - Pfister, David
N1 - © 2022 The Authors. BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company.
PY - 2023/1
Y1 - 2023/1
N2 - OBJECTIVE: To evaluate the relationship between pre-operative PSA value, 68Ga-prostate-specific-membrane-antigen (PSMA) PET performance and oncologic outcomes after salvage lymph node dissection (sLND) for biochemical recurrent prostate cancer (PCa).PATIENTS AND METHODS: The study included 164 patients diagnosed with ≤2 pelvic lymph-node recurrence(s) of PCa documented on 68Ga-PSMA PET scan and treated with pelvic ± retroperitoneal sLND at 11 high-volume centres between 2012 and 2019. Pathologic findings were correlated to PSA values at time of sLND, categorized in early (<0.5 ng/ml), low (0.5-0.99 ng/ml), moderate (1-1.5 ng/ml) and high (>1.5 ng/ml). Clinical recurrence (CR)-free survival after sLND was calculated using multivariable analyses and plotted over pre-operative PSA value.RESULTS: Median [interquartile range (IQR)] PSA at sLND was 1.1 (0.6, 2.0) ng/ml, and 131 (80%) patients had one positive spot at PET scan. All patients received pelvic sLND, whereas 91 (55%) men received also retroperitoneal dissection. Median (IQR) number of node removed was 15 (6, 28). The rate of positive pathology increased as a function of pre-operative PSA value, with highest rates for patients with pre-operative PSA > 1.5 ng/ml (pelvic-only sLNDs: 84%; pelvic + retroperitoneal sLNDs: 90%). After sLND, PSA ≤ 0.3 ng/ml was detected in 67 (41%) men. On multivariable analyses, pre-operative PSA was associated with PSA response (p < 0.0001). There were 51 CRs after sLND. After adjusting for confounders, we found a significant, non-linear relationship between PSA level at sLND and the 12-month CR-free survival (p < 0.0001), with the highest probability of freedom from CR for patients who received sLND at PSA level ≥1 ng/ml.CONCLUSIONS: In case of PET-detected nodal recurrences amenable to sLND, salvage surgery was associated with the highest short-term oncologic outcomes when performed in men with PSA ≥ 1 ng/ml. Awaiting confirmatory data from prospective trials, these findings may help physicians to optimize the timing for 68Ga-PSMA PET in biochemical recurrent PCa.
AB - OBJECTIVE: To evaluate the relationship between pre-operative PSA value, 68Ga-prostate-specific-membrane-antigen (PSMA) PET performance and oncologic outcomes after salvage lymph node dissection (sLND) for biochemical recurrent prostate cancer (PCa).PATIENTS AND METHODS: The study included 164 patients diagnosed with ≤2 pelvic lymph-node recurrence(s) of PCa documented on 68Ga-PSMA PET scan and treated with pelvic ± retroperitoneal sLND at 11 high-volume centres between 2012 and 2019. Pathologic findings were correlated to PSA values at time of sLND, categorized in early (<0.5 ng/ml), low (0.5-0.99 ng/ml), moderate (1-1.5 ng/ml) and high (>1.5 ng/ml). Clinical recurrence (CR)-free survival after sLND was calculated using multivariable analyses and plotted over pre-operative PSA value.RESULTS: Median [interquartile range (IQR)] PSA at sLND was 1.1 (0.6, 2.0) ng/ml, and 131 (80%) patients had one positive spot at PET scan. All patients received pelvic sLND, whereas 91 (55%) men received also retroperitoneal dissection. Median (IQR) number of node removed was 15 (6, 28). The rate of positive pathology increased as a function of pre-operative PSA value, with highest rates for patients with pre-operative PSA > 1.5 ng/ml (pelvic-only sLNDs: 84%; pelvic + retroperitoneal sLNDs: 90%). After sLND, PSA ≤ 0.3 ng/ml was detected in 67 (41%) men. On multivariable analyses, pre-operative PSA was associated with PSA response (p < 0.0001). There were 51 CRs after sLND. After adjusting for confounders, we found a significant, non-linear relationship between PSA level at sLND and the 12-month CR-free survival (p < 0.0001), with the highest probability of freedom from CR for patients who received sLND at PSA level ≥1 ng/ml.CONCLUSIONS: In case of PET-detected nodal recurrences amenable to sLND, salvage surgery was associated with the highest short-term oncologic outcomes when performed in men with PSA ≥ 1 ng/ml. Awaiting confirmatory data from prospective trials, these findings may help physicians to optimize the timing for 68Ga-PSMA PET in biochemical recurrent PCa.
U2 - 10.1002/bco2.182
DO - 10.1002/bco2.182
M3 - SCORING: Journal article
C2 - 36569505
VL - 4
SP - 123
EP - 129
JO - BJUI compass
JF - BJUI compass
SN - 2688-4526
IS - 1
ER -