Prospective Validation of Gallium-68 Prostate Specific Membrane Antigen-Positron Emission Tomography/Computerized Tomography for Primary Staging of Prostate Cancer

No AccessJournal of UrologyAdult Urology1 Mar 2020Prospective Validation of Gallium-68 Prostate Specific Membrane Antigen-Positron Emission Tomography/Computerized Tomography for Primary Staging of Prostate CancerThis article is commented on by the following:Editorial Comment Ludwike W. M. van Kalmthout, Harm H. E. van Melick, Jules Lavalaye, Richard P. Meijer, Anko Kooistra, John M. H. de Klerk, Arthur J. A. T. Braat, H. Peter Kaldeway, Peter C. de Bruin, Bart de Keizer, and Marnix G. E. H. Lam Ludwike W. M. van KalmthoutLudwike W. M. van Kalmthout *Correspondence: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CXUtrecht, The Netherlands telephone: + 31 6 28962091; FAX: +31 88 7569589; E-mail Address: [email protected] Department of Radiology and Nuclear Medicine, University Medical Center, Utrecht, The Netherlands Department of Urology, St. Antonius Hospital, Nieuwegein and Utrecht, The Netherlands More articles by this author , Harm H. E. van MelickHarm H. E. van Melick Department of Urology, St. Antonius Hospital, Nieuwegein and Utrecht, The Netherlands More articles by this author , Jules LavalayeJules Lavalaye Department of Nuclear Medicine, St. Antonius Hospital, Nieuwegein and Utrecht, The Netherlands More articles by this author , Richard P. MeijerRichard P. Meijer Department of Oncological Urology, University Medical Center, Utrecht, The Netherlands More articles by this author , Anko KooistraAnko Kooistra Department of Urology, Meander Medical Center, Amersfoort, The Netherlands More articles by this author , John M. H. de KlerkJohn M. H. de Klerk Department of Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands More articles by this author , Arthur J. A. T. BraatArthur J. A. T. Braat Department of Radiology and Nuclear Medicine, University Medical Center, Utrecht, The Netherlands More articles by this author , H. Peter KaldewayH. Peter Kaldeway Department of Nuclear Medicine, St. Antonius Hospital, Nieuwegein and Utrecht, The Netherlands More articles by this author , Peter C. de BruinPeter C. de Bruin Department of Pathology, St. Antonius Hospital, Nieuwegein and Utrecht, The Netherlands More articles by this author , Bart de KeizerBart de Keizer Department of Radiology and Nuclear Medicine, University Medical Center, Utrecht, The Netherlands More articles by this author , and Marnix G. E. H. LamMarnix G. E. H. Lam Department of Radiology and Nuclear Medicine, University Medical Center, Utrecht, The Netherlands More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000531AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Prospective validation of 68Ga prostate specific membrane antigen positron emission tomography/computerized tomography is lacking in initial staging of prostate cancer. In this study we evaluated the diagnostic accuracy of 68Ga prostate specific membrane antigen positron emission tomography/computerized tomography for detecting lymph node metastasis in patients with intermediate-high risk prostate cancer. Materials and Methods: Patients with newly diagnosed prostate cancer and negative bone scan findings at greater than 10% MSKCC (Memorial Sloan Kettering Cancer Center) risk for lymph node metastasis were prospectively included in study from October 2017 to October 2018. In candidates for extended pelvic lymph node dissection 68Ga prostate specific membrane antigen positron emission tomography/computerized tomography was performed prior to planned surgery. Scan results were evaluated in a second tumor board meeting to assess a potential change of management. Sensitivity, specificity, and positive and negative predictive value for detecting lymph node metastasis were calculated per patient and per resection template using histopathology as the reference. A positron emission tomography based change of management was also reported. Results: A total of 103 patients were eligible for analysis and 97 extended pelvic lymph node dissections were performed. In 41 patients (42.3%) there was a total of 85 lymph node metastases. Positron emission tomography was positive in 17 patients, resulting in 41.5% patient based sensitivity (95% CI 26.7-57.8) for detecting lymph node metastasis. The patient based specificity rate was 90.9% (95% CI 79.3-96.6), and positive and negative predictive values were 77.3% (95% CI 54.2-91.3) and 67.6% (95% CI 55.6-77.7), respectively. A positron emission tomography based change of treatment was observed in 13 patients (12.6%). Conclusions: In patients with newly diagnosed prostate cancer at greater than 10% MSKCC risk for lymph node involvement 68Ga prostate specific membrane antigen positron emission tomography/computerized tomography detected lymph node metastasis with high specificity and moderate sensitivity. This led to a treatment change in 12.6% of patients. References 1. : Cancer statistics. CA Cancer J Clin 2019; 69: 7. 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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. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byMeijer D, de Barros H, van Leeuwen P, Bodar Y, van der Poel H, Donswijk M, Hendrikse N, van Moorselaar R, Nieuwenhuijzen J, Oprea-Lager D and Vis A (2021) The Predictive Value of Preoperative Negative Prostate Specific Membrane Antigen Positron Emission Tomography Imaging for Lymph Node Metastatic Prostate CancerJournal of Urology, VOL. 205, NO. 6, (1655-1662), Online publication date: 1-Jun-2021.van Kalmthout L, Braat A, de Keizer B, Lam M, Meijer R, van Melick H, Lavalaye J, Kaldeway P, Kooistra A and de Klerk J (2020) Prospective Validation of Gallium-68 Prostate Specific Membrane Antigen-Positron Emission Tomography/Computerized Tomography for Primary Staging of Prostate Cancer. Reply.Journal of Urology, VOL. 205, NO. 6, (1839-1840), Online publication date: 1-Jun-2021.Montorsi F, Fossati N, Gandaglia G and Briganti A (2020) Prospective Validation of Gallium-68 Prostate Specific Membrane Antigen-Positron Emission Tomography/Computerized Tomography for Primary Staging of Prostate Cancer. Letter.Journal of Urology, VOL. 205, NO. 6, (1839-1839), Online publication date: 1-Jun-2021.Related articlesJournal of Urology3 Dec 2019Editorial Comment Volume 203Issue 3March 2020Page: 537-545 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordslymph nodespositron emission tomography computed tomographyprostatic neoplasmsneoplasm stagingneoplasm metastasisAcknowledgmentGerard Krijger, Tessa Ververs, Roeland Vis and Rakesh Madho provided research insight and expertise.MetricsAuthor Information Ludwike W. M. van Kalmthout Department of Radiology and Nuclear Medicine, University Medical Center, Utrecht, The Netherlands Department of Urology, St. Antonius Hospital, Nieuwegein and Utrecht, The Netherlands *Correspondence: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CXUtrecht, The Netherlands telephone: + 31 6 28962091; FAX: +31 88 7569589; E-mail Address: [email protected] More articles by this author Harm H. E. van Melick Department of Urology, St. Antonius Hospital, Nieuwegein and Utrecht, The Netherlands More articles by this author Jules Lavalaye Department of Nuclear Medicine, St. Antonius Hospital, Nieuwegein and Utrecht, The Netherlands More articles by this author Richard P. Meijer Department of Oncological Urology, University Medical Center, Utrecht, The Netherlands More articles by this author Anko Kooistra Department of Urology, Meander Medical Center, Amersfoort, The Netherlands More articles by this author John M. H. de Klerk Department of Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands More articles by this author Arthur J. A. T. Braat Department of Radiology and Nuclear Medicine, University Medical Center, Utrecht, The Netherlands More articles by this author H. Peter Kaldeway Department of Nuclear Medicine, St. Antonius Hospital, Nieuwegein and Utrecht, The Netherlands More articles by this author Peter C. de Bruin Department of Pathology, St. Antonius Hospital, Nieuwegein and Utrecht, The Netherlands More articles by this author Bart de Keizer Department of Radiology and Nuclear Medicine, University Medical Center, Utrecht, The Netherlands More articles by this author Marnix G. E. H. Lam Department of Radiology and Nuclear Medicine, University Medical Center, Utrecht, The Netherlands 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. Supported by the Koningin Wilhelmina Fonds (Dutch Cancer Society) Grant No. 11399. 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 ...