68Ga-prostate-specific membrane antigen positron emission tomography/computed tomography for patients with favorable intermediate-risk prostate cancer

Authors

  • Snir Dekalo Tel Aviv Sourasky Medical Center
  • Jonathan Kuten Sackler School of Medicine, Tel-Aviv University
  • Jeffrey Campbell Department of Surgery, Western University
  • Ishai Mintz Department of Urology, Tel-Aviv Sourasky Medical Center
  • Yuval Bar-Yosef Department of Urology, Tel-Aviv Sourasky Medical Center
  • Daniel Keizman Sackler School of Medicine, Tel-Aviv University
  • David Sarid Sackler School of Medicine, Tel-Aviv University
  • Einat Even-Sapir Sackler School of Medicine, Tel-Aviv University
  • Ofer Yossepowitch Department of Urology, Tel-Aviv Sourasky Medical Center
  • Roy Mano Department of Urology, Tel-Aviv Sourasky Medical Center

DOI:

https://doi.org/10.5489/cuaj.7739

Keywords:

favorable intermediate-risk; positron emission tomography; prostate cancer; prostate specific membrane antigen; radical prostatectomy

Abstract

Introduction: Current guidelines do not support the use of pretreatment imaging in patients with favorable intermediate-risk prostate cancer. 68Ga-prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) is more accurate than conventional imaging for preoperative staging. We aimed to evaluate whether pretreatment 68Ga-PSMA PET/CT is beneficial for identifying pathological lymph node involvement (LNI) and adverse pathology among patients with favorable intermediate-risk prostate cancer.

Methods: We reviewed 88 patients with favorable intermediate-risk prostate cancer who underwent 68Ga-PSMA PET/CT prior to radical prostatectomy and lymph node dissection from 2016–2020. The primary endpoint was the presence of pathological LNI. Association between pretreatment characteristics and outcomes were evaluated.

Results: Preoperative 68Ga-PSMA PET/CT showed suspicious uptake in lymph nodes in 4/88 patients (5%), hence, 20 patients would need to be scanned to identify a patient with a positive lymph node on imaging. Two patients had pathological LNI, only one of whom showed 68Ga-PSMA PET/CT uptake prior to surgery. The sensitivity, specificity, positive predictive value, and negative predictive values of 68Ga-PSMA PET/CT for identifying LNI were 50%, 97%, 25%, and 99%, respectively. After surgery, four patients had evidence of prostate-specific antigen (PSA) persistence. The rate of PSA persistence was higher among patients with LNI on preoperative 68Ga-PSMA PET/CT (2/4, 50% vs. 2/84, 2%, p=0.009).

Conclusions: Preoperative imaging of favorable intermediate-risk prostate cancer patients using 68Ga-PSMA PET/CT showed a low yield for identifying patients at higher risk. Consistent with current guidelines, our findings do not support the routine use of PET/CT in this group of patients. Future prospective studies are needed to validate our findings.

Downloads

Download data is not yet available.

Published

2022-02-28

How to Cite

Dekalo, S., Kuten, J. ., Campbell, J. ., Mintz, I. ., Bar-Yosef, Y. ., Keizman, D. ., Sarid, D. ., Even-Sapir, E., Yossepowitch, O. ., & Mano, R. . (2022). 68Ga-prostate-specific membrane antigen positron emission tomography/computed tomography for patients with favorable intermediate-risk prostate cancer. Canadian Urological Association Journal, 16(7), E381–5. https://doi.org/10.5489/cuaj.7739

Issue

Section

Original Research