Prospective Validation of Gallium-68 Prostate Specific Membrane Antigen-Positron Emission Tomography/Computerized Tomography for Primary Staging of Prostate Cancer

Kalmthout, Ludwike W. M. van; Melick, Harm H.E. van; Lavalaye, Jules; Meijer, Richard P.; Kooistra, A.; Klerk, John M. H. de; Braat, Arthur J. A. T.; Kaldeway, H. Peter; Bruin, Peter C. de; Keizer, Bart de; Lam, Marnix G. E. H.

doi:10.1097/ju.0000000000000531

Cited by 91 publications

(69 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Good intra-observer agreement for the detection of pelvic lymph-node metastases using 18 F-DFCPyL PET/CT was observed (95%). Our results appear to be in line with a recent prospective 68 Ga-PSMA study from van Kalmthout et al [16]. This study used a similar methodology to our study (n = 103 patients), applying the same standardized ePLND techniques, histopathology analyses and PET positivity criteria.…”

Section: Discussionsupporting

confidence: 91%

“…This study used a similar methodology to our study (n = 103 patients), applying the same standardized ePLND techniques, histopathology analyses and PET positivity criteria. It revealed a patient-based sensitivity for lymphnode metastases of 41.5% (95%CI 26.7-57.8) and a specificity of 90.9% (95%CI 79.3-96.6) [16]. Although accuracy was similar, we should note that the prevalence of lymph-node metastases in their study was much higher (42.3% vs. our 14.5%).…”

Section: Discussionmentioning

confidence: 59%

“…Only few studies have evaluated the accuracy of PSMA PET/CT for nodal staging of primary PCa, comparing scan results with the histopathology of surgical ePLND specimens. In patients with intermediate and high-risk disease, 68 Ga-PSMA showed modest sensitivity for lymph-node metastatic disease, at consistently high specificity [16][17][18][19]. For 18 F-DCFPyL PET/CT, only a single small prospective series for staging newly diagnosed PCa has been published yet [20].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pelvic lymph-node staging with 18F-DCFPyL PET/CT prior to extended pelvic lymph-node dissection in primary prostate cancer - the SALT trial -

Jansen

Bodar

Zwezerijnen³

et al. 2020

Eur J Nucl Med Mol Imaging

View full text Add to dashboard Cite

Purpose The detection of lymph-node metastases (N1) with conventional imaging such as magnetic resonance imaging (MRI) and computed tomography (CT) is inadequate for primarily diagnosed prostate cancer (PCa). Prostate-specific membrane antigen (PSMA) PET/CT is successfully introduced for the staging of (biochemically) recurrent PCa. Besides the frequently used 68 gallium-labelled PSMA tracers, 18 fluorine-labelled PSMA tracers are available. This study examined the diagnostic accuracy of 18 F-DCFPyL (PSMA) PET/CT for lymph-node staging in primary PCa. Methods This was a prospective, multicentre cohort study. Patients with primary PCa underwent 18 F-DCFPyL PET/CT prior to robot-assisted radical prostatectomy (RARP) with extended pelvic lymph-node dissection (ePLND). Patients were included between October 2017 and January 2020. A Memorial Sloan Kettering Cancer Centre (MSKCC) nomogram risk probability of ≥ 8% of lymph-node metastases was set to perform ePLND. All images were reviewed by two experienced nuclear physicians, and were compared with post-operative histopathologic results. Results A total of 117 patients was analysed. Lymph-node metastases (N1) were histologically diagnosed in 17/117 patients (14.5%). The sensitivity, specificity, positive predictive value and negative predictive value for the 18 F-DCFPyL PET/CT detection of pelvic lymph-node metastases on a patient level were 41.2% (confidence interval (CI): 19.4-66.5%), 94.0% (CI 86.9-97.5%), 53.8% (CI 26.1-79.6%) and 90.4% (CI 82.6-95.0%), respectively. Conclusion 18 F-DCFPyL PET/CT showed a high specificity (94.4%), yet a limited sensitivity (41.2%) for the detection of pelvic lymph-node metastases in primary PCa. This implies that current PSMA PET/CT imaging cannot replace diagnostic ePLND. Further research is necessary to define the exact place of PSMA PET/CT imaging in the primary staging of PCa.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pelvic lymph-node staging with 18F-DCFPyL PET/CT prior to extended pelvic lymph-node dissection in primary prostate cancer - the SALT trial -

Jansen

Bodar

Zwezerijnen³

et al. 2020

Eur J Nucl Med Mol Imaging

View full text Add to dashboard Cite

show abstract

“…It is important to notice that this was a highly selected subpopulation with a massive selection bias, as the patients scheduled for surgery are usually deemed free of metastatic disease by 68 Ga-PSMA PET/CT beforehand. Our sensitivity was on par with comparable studies (RP with PLND) reporting sensitivities spanning from 33-42% (25)(26)(27)(28). This selection bias is illustrated by the much higher sensitivity found by Hofman et al, in their recent prospective study of 68 Ga-PSMA PET/CT in a less preselected group (6).…”

Section: Discussionsupporting

confidence: 56%

⁶⁸Ga-PSMA PET/CT for Primary Lymph Node and Distant Metastasis NM Staging of High-Risk Prostate Cancer

et al. 2020

View full text Add to dashboard Cite

With the largest high-risk prostate cancer (PCa) cohort to date undergoing 68 Ga-prostate-specific membrane antigen (PSMA) PET/CT primary staging, we aimed to 1) characterize the metastatic spread of PCa in relation to tumor 68 Ga-PSMA-uptake and the D'Amico classification, and 2) compare 68 Ga-PSMA PET/CT findings with radical prostatectomy (RP) with pelvic lymph node dissection (PLND) histopathology. Methods A total of 691 consecutive newly diagnosed, biopsy-proven, treatment-naïve, D'Amico high-risk PCa patients primary staged by 68 Ga-PSMA PET/CT were included. PSMA maximum standardized uptake value (SUV max) and metastatic findings were compared to PSA level, International Society of Urologic Pathology (ISUP) grade, and clinical stage as traditional risk stratification parameters. Moreover, 68 Ga-PSMA PET/CT findings were compared with histology in RP patients undergoing PLND. Undetected lymph node metastases (LNMs) underwent immunohistochemical PSMA staining. Results Advanced disease (N1/M1) was observed in 35.3% of patients (244/691) and was associated with increasing PSA levels, ISUP grades, and clinical stages. LNMs (N1/M1a) were detected in 31.4% (217/691) and bone metastases (M1b) in 16.8% (116/691). Advanced disease frequencies in patients with ISUP grade 2 and 3 were 10.8% (11/102) and 37.1% (33/89), respectively. Risk of advanced disease for cT2a/cT2b/cT2c tumors were almost equal (24.2%, 27.9%, and 22.4%, respectively). We observed a weak correlation between SUV max and biopsy ISUP grade (ρ = 0.21; P < 0.001) and a modest correlation between SUV max and post-prostatectomy ISUP grade (ρ = 0.38; P < 0.001). Sensitivity, specificity, positive and negative predictive value, and accuracy for LNMs detection on 68 Ga-PSMA PET/CT in the PLND cohort were 30.6%, 96.5%, 68.8%, 84.5%, and 83.1%, respectively. Undetected LNMs were either micrometastases located in the lymph node border or without PSMA expression. Conclusion In this high-risk PCa cohort, we identified advanced disease in about one-third at diagnosis. ISUP grade was the superior predictor for advanced disease at diagnosis. We found a significant difference in frequency of advanced disease between ISUP grade 2 and 3, which supports the Gleason Score 7 subdivision. Interestingly, we observed no significant differences in risk of advanced disease when comparing the different cT2 stages. The undetected LNMs were either PSMA-negative or micrometastases.

show abstract

“…These authors specifically identified difficulties (sampling errors, missed nodes) in using histopathology of resected nodes as ground truth, so they reported their numbers on patient level rather than on nodal level and incorporated 6-month follow-up with repeated imaging for validation. Contrary to these high values, other recent data show low sensitivities of PSMA PET-CT in the detection of lymph node metastases of 42%, 40 41% (SALT trial), 41 and 31% 42 at high specificities of 91%, 94%, and 97% respectively. In these studies, the median size of missed metastases was 3 mm or less, significantly smaller than the median size of detected metastases (exemplified in Fig.…”

Section: Why Are Lymph Nodes Important For Oncologic Staging?mentioning

confidence: 65%

The Role of Magnetic Resonance Imaging in (Future) Cancer Staging

Scheenen¹,

Zámecnik

2021

Invest Radiol

View full text Add to dashboard Cite

show abstract

Prospective Validation of Gallium-68 Prostate Specific Membrane Antigen-Positron Emission Tomography/Computerized Tomography for Primary Staging of Prostate Cancer

Cited by 91 publications

References 0 publications

Pelvic lymph-node staging with 18F-DCFPyL PET/CT prior to extended pelvic lymph-node dissection in primary prostate cancer - the SALT trial -

Pelvic lymph-node staging with 18F-DCFPyL PET/CT prior to extended pelvic lymph-node dissection in primary prostate cancer - the SALT trial -

⁶⁸Ga-PSMA PET/CT for Primary Lymph Node and Distant Metastasis NM Staging of High-Risk Prostate Cancer

The Role of Magnetic Resonance Imaging in (Future) Cancer Staging

Contact Info

Product

Resources

About

Prospective Validation of Gallium-68 Prostate Specific Membrane Antigen-Positron Emission Tomography/Computerized Tomography for Primary Staging of Prostate Cancer

Cited by 91 publications

References 0 publications

Pelvic lymph-node staging with 18F-DCFPyL PET/CT prior to extended pelvic lymph-node dissection in primary prostate cancer - the SALT trial -

Pelvic lymph-node staging with 18F-DCFPyL PET/CT prior to extended pelvic lymph-node dissection in primary prostate cancer - the SALT trial -

68Ga-PSMA PET/CT for Primary Lymph Node and Distant Metastasis NM Staging of High-Risk Prostate Cancer

The Role of Magnetic Resonance Imaging in (Future) Cancer Staging

Contact Info

Product

Resources

About

⁶⁸Ga-PSMA PET/CT for Primary Lymph Node and Distant Metastasis NM Staging of High-Risk Prostate Cancer