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Clinical Research

Preoperative 68Ga-PSMA PET/CT defines a subgroup of high-risk prostate cancer patients with favorable outcomes after radical prostatectomy and lymph node dissection

Prostate Cancer and Prostatic Diseases volume 24, pages 910–916 (2021)Cite this article

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Abstract

Background

High-risk prostate cancer is associated with adverse pathology and unfavorable outcomes after radical prostatectomy. 68Ga-PSMA PET/CT is more accurate than conventional imaging for preoperative staging. We aimed to evaluate whether lymph node involvement on 68Ga-PSMA PET/CT prior to radical prostatectomy in patients with high-risk prostate cancer is associated with worse short-term oncologic outcomes.

Methods

We retrospectively reviewed 149 patients with high-risk localized or locoregional prostate cancer who underwent 68Ga-PSMA PET/CT prior to radical prostatectomy between 2015 and 2020. None of the patients received neoadjuvant or adjuvant treatment. The study endpoints were PSA persistence and biochemical recurrence. Logistic regression models were used to identify preoperative predictors of PSA persistence. Kaplan–Meier analyses were used to estimate biochemical recurrence-free survival.

Results

Of 149 identified patients, 19 (13%) were found to have lymph node involvement on preoperative 68Ga-PSMA PET/CT. The sensitivity, specificity, and accuracy of 68Ga-PSMA PET/CT for identifying pathologic lymph node involvement were 68%, 95%, and 92%, respectively. PSA persistence rate was lower among patients with PET-negative lymph nodes than those with PET-positive nodes (15 vs. 84%, p < 0.001). Positive nodes on imaging (OR = 41.03, p < 0.001) and clinical T2c–T3 stage (OR = 6.96, p = 0.002) were associated with PSA persistence on multivariable analysis. Among patients with PET-negative nodes the 1- and 2-year biochemical recurrence-free survival rates were 87% and 76%, respectively.

Conclusions

Preoperative staging with 68Ga-PSMA PET/CT may identify a subgroup of high-risk prostate cancer patients with favorable short-term outcomes after radical prostatectomy without adjuvant treatment. Future studies will evaluate whether these results are sustained during long-term follow-up.

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Fig. 1: Bar plots for pathologic lymph node involvement and PSA persistance by node status on PSMA PET/CT and node size.
Fig. 2: Kaplan-Meier curve of biochemical recurrence-free survival.

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Acknowledgements

We would like to thank Ms. Elizabeta Davidov for her assistance in compiling the data for the study.

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Authors and Affiliations

  1. Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel

    Snir Dekalo, Ishai Mintz, Haim Matzkin, Nicola J. Mabjeesh, Avi Beri, Ofer Yossepowitch & Roy Mano

  2. Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel

    Jonathan Kuten & Einat Even-Sapir

  3. Department of Pathology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel

    Ibrahim Fahoum & Gilad Gitstein

  4. Department of Oncology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel

    Daniel Keizman & David Sarid

  5. Department of Urology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel

    Nicola J. Mabjeesh

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  1. Snir Dekalo
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Correspondence to Roy Mano.

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Dekalo, S., Kuten, J., Mintz, I. et al. Preoperative 68Ga-PSMA PET/CT defines a subgroup of high-risk prostate cancer patients with favorable outcomes after radical prostatectomy and lymph node dissection. Prostate Cancer Prostatic Dis 24, 910–916 (2021). https://doi.org/10.1038/s41391-021-00347-y

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