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68Ga-PSMA PET/CT based primary staging and histological correlation after extended pelvic lymph node dissection at radical prostatectomy

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Abstract

Introduction

Prostate-specific membrane antigen positron emission tomography-computed tomography (PSMA PET/CT) represents the upcoming standard for the staging of prostate cancer (PCa). However, there is still an unmet need for the validation of PSMA PET/CT at primary staging and consecutive histological correlation. Consequently, we decided to analyze the prediction parameter of PSMA PET/CT at primary staging.

Methods

We relied on 90 ≥ intermediate-risk PCa patients treated with radical prostatectomy (RP) and extended pelvic lymph node dissection. All patients were administered to 68Ga-PSMA PET/CT prior to surgery. 68Ga-PSMA PET/CT data were retrospectively reevaluated by a single radiologist and consequently compared to histological results from RP. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the detection of lymph node metastases were analyzed per-patient (n = 90), per-pelvic side (n = 180), and per-anatomic-region (external iliac artery and vein left/right vs. obturator fossa left/right vs. internal iliac artery left/right) (n = 458), respectively.

Results

Sensitivity, specificity, PPV, and NPV per-patient were: 43.8, 96.0, 70.0, and 88.8%, respectively. Sensitivity, specificity, PPV, and NPV per-pelvic-side were: 42.9, 95.6, 56.3, and 92.7%, respectively. Sensitivity, specificity, PPV, and NPV per-anatomic-region were: 47.6, 98.9, 66.7, and 97.5%, respectively.

Conclusions

Negative 68Ga-PSMA PET/CT results were highly reliable in our study. Positive 68Ga-PSMA PET/CT results, however, revealed less reliable results. Larger and ideally prospective trials are justified to clarify the potential role of PSMA PET/CT based primary staging.

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Authors and Affiliations

  1. Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany

    J. Kopp, E. Bernhardt, L. Manka, A. Beck & P. Hammerer

  2. Department of Urology, Klinikum Bogenhausen, Munich, Germany

    J. Kopp

  3. Department of Radiology, Academic Hospital Braunschweig, Braunschweig, Germany

    D. Kopp & W. Schoerner

  4. Department of Radiology, RoMed Klinikum Rosenheim, Rosenheim, Germany

    D. Kopp

  5. University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany

    H. Gerullis & Jonas Schiffmann

  6. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada

    P. Karakiewicz

  7. Department of Urology, University of Montreal Health Center, Montreal, Canada

    P. Karakiewicz

Authors
  1. J. Kopp
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  2. D. Kopp
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  3. E. Bernhardt
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  4. L. Manka
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  5. A. Beck
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  6. H. Gerullis
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  7. P. Karakiewicz
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  8. W. Schoerner
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  9. P. Hammerer
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  10. Jonas Schiffmann
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Contributions

JK: Data collection and management, Manuscript writing. DK: Data collection. EB: Data management. LM: Data management. AB: Data collection. HG: Manuscript editing. PK: Manuscript writing. WS: Project development. PH: Project development, Manuscript writing. JS: Project development, Manuscript writing, Data analysis.

Corresponding author

Correspondence to Jonas Schiffmann.

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The authors declare that they have no conflict of interest.

Research involving human participants and/or animals and informed consent

The study has been performed in accordance with the ethical standards as laid down in the Declaration of Helsinki and its ethical standards.

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Kopp, J., Kopp, D., Bernhardt, E. et al. 68Ga-PSMA PET/CT based primary staging and histological correlation after extended pelvic lymph node dissection at radical prostatectomy. World J Urol 38, 3085–3090 (2020). https://doi.org/10.1007/s00345-020-03131-0

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  • DOI: https://doi.org/10.1007/s00345-020-03131-0

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