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

Authors
  • Ferraro, Daniela A1
  • Lehner, Fabienne2
  • Becker, Anton S3, 4
  • Kranzbühler, Benedikt2
  • Kudura, Ken1
  • Mebert, Iliana1, 2
  • Messerli, Michael1
  • Hermanns, Thomas2
  • Eberli, Daniel2
  • Burger, Irene A5, 6
  • 1 Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zürich, Switzerland. , (Switzerland)
  • 2 Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. , (Switzerland)
  • 3 Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. , (Switzerland)
  • 4 Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA.
  • 5 Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zürich, Switzerland. [email protected] , (Switzerland)
  • 6 Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland. [email protected] , (Switzerland)
Type
Published Article
Journal
European Journal of Nuclear Medicine
Publisher
Springer-Verlag
Publication Date
Apr 01, 2021
Volume
48
Issue
4
Pages
1219–1228
Identifiers
DOI: 10.1007/s00259-020-05058-5
PMID: 33074376
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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. 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. 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.

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