Mapping prostate cancer lesions before and after unsuccessful salvage lymph node dissection using repeat PSMA PET

• Verfasst von: Farolfi, Andrea [VerfasserIn]
• Verfasst von: Ilhan, Harun [VerfasserIn]
• Verfasst von: Gafita, Andrei [VerfasserIn]
• Verfasst von: Calais, Jeremie [VerfasserIn]
• Verfasst von: Barbato, Francesco [VerfasserIn]
• Verfasst von: Weber, Manuel [VerfasserIn]
• Verfasst von: Afshar-Oromieh, Ali [VerfasserIn]
• Verfasst von: Spohn, Fabian [VerfasserIn]
• Verfasst von: Wetter, Axel [VerfasserIn]
• Verfasst von: Rischpler, Christoph [VerfasserIn]
• Verfasst von: Hadaschik, Boris [VerfasserIn]
• Verfasst von: Pianori, Davide [VerfasserIn]
• Verfasst von: Fanti, Stefano [VerfasserIn]
• Verfasst von: Haberkorn, Uwe [VerfasserIn]
• Verfasst von: Eiber, Matthias [VerfasserIn]
• Verfasst von: Herrmann, Ken [VerfasserIn]
• Verfasst von: Fendler, Wolfgang Peter [VerfasserIn]
• Titel: Mapping prostate cancer lesions before and after unsuccessful salvage lymph node dissection using repeat PSMA PET
• Verf.angabe: Andrea Farolfi, Harun Ilhan, Andrei Gafita, Jeremie Calais, Francesco Barbato, Manuel Weber, Ali Afshar-Oromieh, Fabian Spohn, Axel Wetter, Christoph Rischpler, Boris Hadaschik, Davide Pianori, Stefano Fanti, Uwe Haberkorn, Matthias Eiber, Ken Herrmann, and Wolfgang Peter Fendler
• Jahr: 2020
• Jahr des Originals: 2019
• Umfang: 6 S.
• Teil: volume:61
• Teil: year:2020
• Teil: number:7
• Teil: pages:1037-1042
• Teil: extent:6
• Fussnoten: Published online Dec. 5, 2019 ; Gesehen am 17.09.2020
• Titel Quelle: Enthalten in: Journal of nuclear medicine
• Ort Quelle: New York, NY : Soc., 1964
• Jahr Quelle: 2020
• Band/Heft Quelle: 61(2020), 7, Seite 1037-1042
• ISSN Quelle: 2159-662X
• ISSN Quelle: 1535-5667
• DOI: doi:10.2967/jnumed.119.235374
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Genitourinary
• Sach-SW: Oncology: GU
• Sach-SW: PET/CT
• Sach-SW: positron emission tomography (PET)
• Sach-SW: prostate cancer
• Sach-SW: PSA persistence
• Sach-SW: PSMA
• Sach-SW: salvage lymph node dissection
• K10plus-PPN: 1695633849

Abstract

Introduction: The aim of this study was to analyze patterns of persistent versus recurrent or new PET lesions in a selected patient cohort with PSA persistence following salvage lymph node dissection (SLND) and pre/post procedure prostate-specific membrane antigen ligand positron emission tomography (PSMA-PET). Material and Methods: 16 patients were included in this multicenter study. Inclusion criteria were: a) PSMA-PET performed for biochemical recurrence before SLND (pre-SLND PET) and b) repeat PSMA-PET performed for persistently elevated PSA level (≥0.1 ng/mL) ≥6 weeks after SLND (post-SLND PET). Image analysis was performed by three independent nuclear medicine physicians applying the molecular imaging TNM system PROMISE. Lesions were confirmed by histopathology, presence on correlative CT/MRI/bone scan or PSA response after focal therapy. Results: post-SLND PET identified PCa-lesions in 88% (14/16) of patients with PSA persistence after SLND. Median PSA was 1.2 ng/mL (IQR, 0.6-2.8 ng/mL). Disease was confined to the pelvis in 56% of patients (9/16) and most of these men had common iliac (6/16, 38%) and internal iliac lymph node metastases (6/16, 38%). Extrapelvic disease was detected in 31% of patients (5/16). In pre- and post-SLND PET comparison, 10/16 had at least one lesion already detected at baseline (63% PET persistence); 4/16 had new lesions only (25% PET recurrence); 2 had no disease on post-SLND PET. All validated regions (11 regions in 9 patients) were true positive. 9/14 (64%) patients underwent repeat local therapies after SLND (7/14 radiotherapy, 2/14 surgery). Conclusion: SLND of pelvic nodal metastases was often not complete according to PSMA-PET. About two thirds of patients had PET positive nodal disease after SLND already seen on pre-SLND PSMA-PET. Notably, about one quarter of patients had new lesions, not detected by pre-surgical PSMA-PET.