Diagnostic Accuracy of ⁶⁸Ga-PSMA-11 PET for Pelvic Nodal Metastasis Detection Prior to Radical Prostatectomy and Pelvic Lymph Node Dissection

Abstract

IMPORTANCEThe presence of pelvic nodal metastases at radical prostatectomy is associated with biochemical recurrence after prostatectomy. OBJECTIVE To assess the accuracy of prostate-specific membrane antigen (PSMA) 68 Ga-PSMA-11 positron emission tomographic (PET) imaging for the detection of pelvic nodal metastases compared with histopathology at time of radical prostatectomy and pelvic lymph node dissection. DESIGN, SETTING, AND PARTICIPANTS This investigator-initiated prospective multicenter single-arm open-label phase 3 imaging trial of diagnostic efficacy enrolled 764 patients with intermediate-to high-risk prostate cancer considered for prostatectomy at

External Validation and Comparison of Two Nomograms Predicting the Probability of Lymph Node Involvement in Patients subjected to Robot-Assisted Radical Prostatectomy and Concomitant Lymph Node Dissection: A Single Tertiary Center Experience in the MRI-Era

“…In this context, possible future developments could come from the widespread adoption of PSMA PET/CT. The diagnostic accuracy of PSMA PET/CT was found to be significantly higher than that of conventional imaging techniques in the detection of nodal metastasis in intermediate-high risk PCa, although not such as to replace ePLND (35)(36)(37). On the contrary, its role in the local staging remains controversial with several limitations and has not been shown to be superior to mpMRI (38)(39)(40).…”

Evaluation of Predictors of Biochemical Recurrence in Prostate Cancer Patients, as Detected by 68Ga-PSMA PET/CT

“…The scan results were defined as “positive”, “negative” or “equivocal”. Positive was defined as visually avid focal tracer uptake not associated with physiological uptake and higher than adjacent tissue, and hence suspicious of malignancy, these criteria are in accordance with Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE) guidelines [ 16 ] and with the major publications on this topic [ 15 , 17 , 18 ]. Equivocal was defined as cases with increased focal tracer uptake where it was not possible to distinguished between a benign or malignant condition, which in most cases leads to a follow-up biopsy or MRI scan.…”

Feasibility and Optimal Time Point of [68Ga]Gallium-labeled Prostate-specific Membrane Antigen Ligand Positron Emission Tomography Imaging in Patients Undergoing Cytoreductive Surgery After Systemic Therapy for Primary Oligometastatic Prostate Cancer: Implications for Patient Selection and Extent of Surgery

“…The introduction of prostate-specific membrane antigen (PSMA) targeted molecular imaging using positron emission tomography (PET) has significantly enriched the diagnostic and therapeutic landscape of prostate cancer (PCA). It is an accurate imaging modality for local, regional, and distant staging in primary, recurrent, metastatic, as well as castration-resistant PCA [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] . The most widely used and only guideline-recommended indication is at the time of biochemical recurrence (BCR) after local treatment with curative intent [4] , [9] , [10] , [11] , to differentiate between local and metastatic recurrence.…”

“…In patients with presumed high-risk localized disease, the use of PSMA-PET has led to a disease state shift, partly due to its improved sensitivity for oligometastases compared with standard imaging. Many oligometastatic PCA patients diagnosed by PSMA-PET show no evidence of systemic disease when assessed using standard imaging, which includes a bone scan (BS) and computer tomography (CT) [2] , [7] , [8] , [12] , [13] . This has led to an increased use of local radical therapy in patients with oligometastatic PCA, commonly after a response to systemic therapy [14] , [15] .…”