⁶⁸Ga‐PSMA‐PET/CT helps to select patients for salvage radical prostatectomy with local recurrence after primary radiotherapy for prostate cancer

Abstract

Objective To investigate the diagnostic performance of gallium‐68 prostate‐specific membrane antigen positron emission tomography/computed tomography (68Ga‐PSMA PET/CT) in patients with recurrent prostate cancer with regard to the presence of lymph node metastases (LNM) and local recurrences after primary radiotherapy. Patients and methods We retrospectively reviewed 142 patients following salvage radical prostatectomy (sRP), 50 of which had a 68Ga‐PSMA PET/CT performed as a preoperative staging module. Predictive clinical parameters were analysed in a multivariate Cox regression analysis. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) and the accuracy of 68Ga‐PSMA PET/CT were analysed with regard to LNM and local recurrence. Results In all, 613 lymph nodes were resected in 40 patients and 23 lymph nodes had metastatic deposits in 14 patients. In all patients local recurrence could have been found with 68Ga‐PSMA PET/CT. Sensitivity, specificity, PPV and NPV and accuracy on a per lymph node basis were 34.78% (16.38–57.2%), 100% (99.38–100%), 100%, 97.52% (96.69–98.15%) and 97.55% (96.00–98.62%). For detecting local recurrence, the sensitivity and PPV were both 100% with an accuracy of 100% (92.89–100%). Conclusion 68Ga‐PSMA PET/CT should be the standard imaging in biochemical recurrent prostate cancer. With this imaging module one detects first local recurrence and can detect locoregional and distant metastases more precisely than standard CT and bone scan.

Defining radio-recurrent intra-prostatic target volumes using PSMA-targeted PET/CT and multi-parametric MRI

“…Dinis Fernandes et al showed that in 5/21 patients with radio-recurrence, radiologist contours on mpMRI did not visually overlap with step-section pathology [10]. Similarly, for PSMA-targeted PET/CT, Pfister et al reported per-lobe sensitivity and NPV of 81% and 32% respectively based on salvage prostatectomy in patients previously treated with RT or HIFU [26]. In our study, even with combined PET/CT and mpMRI, the false negative rate per-lobe was 11%.…”

The role of lymph node dissection in salvage radical prostatectomy for patients with radiation recurrent prostate cancer

“… 31 , 32 , 33 Indeed, several studies have demonstrated the superiority of PSMA PET/CT over conventional imaging in staging patients with radiation recurrent PCa. 34 , 35 Despite these limitations, we were able to present the first study to comprehensively analyze the role of lymph node yield and the number of positive lymph nodes in patients with radiation recurrent PCa treated with SRP.…”

Concordance of biopsy and pathologic ISUP grading in salvage radical prostatectomy patients for recurrent prostate cancer

“…Especially due to the advent of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) before SRP, very important details on disease burden are unmasked and should be an integral part of the staging routine in this setting. 13,14 In this regard, PSMA PET helps in the clinical decision-making process and eventually may decrease overtreatment rates in patients who already present with nodal or distant metastasis. Indeed, as evidenced by previous analyses, the presence of positive lymph nodes is a significant contributor to worse oncological outcomes including biochemical recurrence, metastatic progression, and ultimately also cancer-specific mortality.…”