Outcomes of Primary Lymph Node Staging of Intermediate and High Risk Prostate Cancer with 68 Ga-PSMA Positron Emission Tomography/Computerized Tomography Compared to Histological Correlation of Pelvic Lymph Node Pathology

No AccessJournal of UrologyNew Technology and Techniques1 Apr 2019Outcomes of Primary Lymph Node Staging of Intermediate and High Risk Prostate Cancer with 68Ga-PSMA Positron Emission Tomography/Computerized Tomography Compared to Histological Correlation of Pelvic Lymph Node PathologyThis article is commented on by the following:Editorial Comment John W. Yaxley, Sheliyan Raveenthiran, François-Xavier Nouhaud, Hemamali Samartunga, Anna J. Yaxley, Geoff Coughlin, Brett Delahunt, Lars Egevad, Louise McEwan, and David Wong John W. YaxleyJohn W. Yaxley *Correspondence: Wesley Urology Clinic, Auchenflower, Queensland , Australia (e-mail: E-mail Address: [email protected]). Wesley Urology Clinic, Brisbane, Queensland, Australia Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia Brisbane and Department of Medicine, University of Queensland, Herston, Queensland, Australia More articles by this author , Sheliyan RaveenthiranSheliyan Raveenthiran Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia More articles by this author , François-Xavier NouhaudFrançois-Xavier Nouhaud Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia Department of Urology, Rouen University Hospital, Rouen, France More articles by this author , Hemamali SamartungaHemamali Samartunga Aquesta Uro-Pathology, Brisbane, Queensland, Australia Brisbane and Department of Medicine, University of Queensland, Herston, Queensland, Australia More articles by this author , Anna J. YaxleyAnna J. Yaxley School of Medicine, Griffith University, Brisbane, Queensland, Australia More articles by this author , Geoff CoughlinGeoff Coughlin Wesley Urology Clinic, Brisbane, Queensland, Australia Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia More articles by this author , Brett DelahuntBrett Delahunt Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, Newtown, Wellington, New Zealand More articles by this author , Lars EgevadLars Egevad Department of Oncological Pathology, Karolineska Institute, Stockholm, Sweden More articles by this author , Louise McEwanLouise McEwan Wesley Medical Imaging, Brisbane, Queensland, Australia More articles by this author , and David WongDavid Wong Wesley Medical Imaging, Brisbane, Queensland, Australia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000053AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The majority of men who undergo pelvic lymph node dissection at radical prostatectomy have benign lymph node histology. The aim of this study was to assess the predictive value of preoperative 68Ga-PSMA (prostate specific membrane antigen) positron emission tomography/computerized tomography to predict histological metastasis on pelvic lymph node dissection performed during radical prostatectomy. Materials and Methods: We retrospectively reviewed the sensitivity, specificity, and positive and negative predictive values of preoperative staging 68Ga-PSMA positron emission tomography/computerized tomography to identify histological lymph node metastasis in 208 consecutive men who subsequently proceeded with pelvic lymph node dissection at radical prostatectomy. Results: Median prostate specific antigen was 7.6 μg/l, the lymph node count was 13 and Gleason score was 4 + 5. On a per patient basis only 21 of the 55 men with metastasis on histological examination were identified on 68Ga-PSMA positron emission tomography/computerized tomography for 38.2% sensitivity. Of the 143 men with no lymph node metastasis on 68Ga-PSMA imaging 34 had metastasis on histology for 80.8% negative predictive value. Specificity was 93.5% and positive predictive value was 67.7%. For the 172 histologically identified malignant lymph node metastases the sensitivity per node was 24.4% and specificity was 99.5%. Conclusions: If negative 68Ga-PSMA positron emission tomography/computerized tomography is used as the basis of not performing pelvic lymph node dissection, 80% of men would avoid unnecessary pelvic lymph node dissection. However, 68Ga-PSMA positron emission tomography/computerized tomography has poor sensitivity per node to detect all histologically positive lymph node metastases. Thus, pelvic lymph node dissection remains the gold standard to stage pelvic lymph nodes despite its known limitations and complications. 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The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byTaneja S (2020) Re: Prostate-Specific Membrane Antigen PET-CT in Patients with High-Risk Prostate Cancer before Curative-Intent Surgery or Radiotherapy (proPSMA): A Prospective, Randomised, Multicentre StudyJournal of Urology, VOL. 204, NO. 4, (878-879), Online publication date: 1-Oct-2020.Fossati N, Scarcella S, Gandaglia G, Suardi N, Robesti D, Boeri L, Karnes R, Heidenreich A, Pfister D, Kretschmer A, Buchner A, Stief C, Battaglia A, Joniau S, Van Poppel H, Osmonov D, Juenemann K, Shariat S, Hiester A, Nini A, Albers P, Tilki D, Graefen M, Gill I, Mottrie A, Galosi A, Montorsi F and Briganti A (2020) Underestimation of Positron Emission Tomography/Computerized Tomography in Assessing Tumor Burden in Prostate Cancer Nodal Recurrence: Head-to-Head Comparison of 68Ga-PSMA and 11C-Choline in a Large, Multi-Institutional Series of Extended Salvage Lymph Node DissectionsJournal of Urology, VOL. 204, NO. 2, (296-302), Online publication date: 1-Aug-2020.Taneja S (2020) Re: 3-Year Freedom from Progression following 68GaPSMA PET CT Triaged Management in Men with Biochemical Recurrence Post Radical Prostatectomy. 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Yaxley Wesley Urology Clinic, Brisbane, Queensland, Australia Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia Brisbane and Department of Medicine, University of Queensland, Herston, Queensland, Australia *Correspondence: Wesley Urology Clinic, Auchenflower, Queensland , Australia (e-mail: E-mail Address: [email protected]). More articles by this author Sheliyan Raveenthiran Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia More articles by this author François-Xavier Nouhaud Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia Department of Urology, Rouen University Hospital, Rouen, France More articles by this author Hemamali Samartunga Aquesta Uro-Pathology, Brisbane, Queensland, Australia Brisbane and Department of Medicine, University of Queensland, Herston, Queensland, Australia More articles by this author Anna J. Yaxley School of Medicine, Griffith University, Brisbane, Queensland, Australia More articles by this author Geoff Coughlin Wesley Urology Clinic, Brisbane, Queensland, Australia Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia More articles by this author Brett Delahunt Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, Newtown, Wellington, New Zealand More articles by this author Lars Egevad Department of Oncological Pathology, Karolineska Institute, Stockholm, Sweden More articles by this author Louise McEwan Wesley Medical Imaging, Brisbane, Queensland, Australia More articles by this author David Wong Wesley Medical Imaging, Brisbane, Queensland, Australia More articles by this author Expand All No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. Advertisement PDF downloadLoading ...