Improved oncological outcome after radical prostatectomy in patients staged with 68Ga-PSMA-11 PET: a single-center retrospective cohort comparison

Abstract

Background Positron emission tomography (PET) targeting the prostate-specific membrane antigen (PSMA) has superior sensitivity over conventional imaging (CI) to stage prostate cancer (PCa) and therefore is increasingly used in staging to stratify patients before radical therapy. Whether this improved diagnostic accuracy translates into improved outcome after radical prostatectomy (RPE) has not yet been shown. Therefore, the aim of this study was to compare the oncological outcome after RPE between patients that underwent preoperative staging with CI or PSMA-PET for intermediate and high-risk PCa. Methods We retrospectively selected all patients that underwent RPE for intermediate- or high-risk PCa at our institution before PSMA-PET introduction (between March 2014 and September 2016) and compared the oncologic outcome of patients staged with PSMA-PET (between October 2016 and October 2018). Oncological pre-surgical risk parameters (age, PSA, D’Amico score, biopsy-ISUP, and cT stage) were compared between the groups. Oncological outcome was determined as PSA persistence, nerve-sparing rate, and surgical margin status. Wilcoxon rank-sum, Fisher’s, and chi-square tests where used for statistical testing. Results One hundred five patients were included, 53 in the CI group and 52 in the PSMA-group. Patients in the PSMA group had higher ISUP grade (p < 0.001) and D’Amico score (p < 0.05). The rate of free surgical margins and PSA persistence after RPE was 64% and 17% for the CI and 77% and 6% for the PSMA group (p = 0.15 and 0.13, respectively). Subgroup analysis with high-risk patients revealed PSA persistence in 7% (3/44) in the PSMA group and 25% (7/28) in the CI group (p = 0.04). Limitations include the retrospective design and choline-PET for some patients in the CI group. Conclusion Immediate outcome after RPE was not worse in the PSMA group compared with the CI group, despite a higher-risk cohort. In a comparison of only high-risk patients, PSMA-PET staging was associated with a significantly lower rate of postsurgical PSA persistence.

Yüksek Ri̇skli̇ Prostat Kanseri̇nde 68ga-Psma Pet/Bt’ni̇n Tedavi̇ Yöneti̇mi̇ne Etki̇si̇

“…They found that metastasis rate was higher in the high risk group, compared to intermediate risk patients, 19.9% vs. 5.2%, in line with our previous study (17). Recently, Ferraro et al published that PSMA PET significantly improved post-RP outcome comparison to conventional imaging, especially in high-risk PCa patients (25). These results suggest that the impact of PSMA PET is limited in therapy management of intermediate patients, compared to high risk patients.…”

The Performance of FDA-Approved PET Imaging Agents in the Detection of Prostate Cancer

“…The treatment change in the full cohort was 57% after imaging with [ 68 Ga]Ga-PSMA-11 [ 74 ]. In another study, [ 68 Ga]Ga-PSMA-11 could predict the treatment outcome for RP better than conventional imaging, including [ 11 C]choline PET/CT, contrast-enhanced CT, bone scan, or abdominal MRI [ 75 ].…”

Aktuelle radiopharmazeutische Entwicklungen für die theranostische Anwendung

“…[ 68 Ga]Ga-PSMA-11 wurde kürzlich von der US-amerikanischen Arzneimittelbehörde FDA zur Diagnostik des Prostatakarzinoms an zwei Kliniken in den USA zugelassen [4], die Überlegenheit von [ 68 Ga]Ga-PSMA-11 gegenüber konventionellen Methoden wurde gezeigt [5][6][7][8]. Die PS-MA-Radioligandentherapie wurde in klinischen Studien er-…”