Diagnostic value of presurgical 68Ga-PSMA-11 PET/CT in prostate cancer patients with different ISUP grade groups.

Unilateral Pelvic Lymph Node Dissection in Prostate Cancer Patients Diagnosed in the Era of Magnetic Resonance Imaging-targeted Biopsy: A Study That Challenges the Dogma.

Pelvic lymph node (LN) metastasis is a well-recognized route of prostate cancer spread. However, the relationship between topography and the pathologic features of primary prostatic cancers and patterns of pelvic LN metastasis has not been well studied. We reviewed original slides of radical prostatectomies and pelvic LN dissections from 125 patients with LN metastasis and recorded a total number of LN excised/laterality of positive LN, and localization, staging parameters, lymphovascular invasion, and volume of primary tumors. 14.6 (mean) and 13 (median) LNs were resected. Seventy-six (61%), 33 (26%), and 16 (13%) cases had 1, 2, and >2 positive LNs; whereas 58, 44, and 20 cases had LN metastasis on the right, left, and bilaterally. Eighty-six percent (108 of 125) and 37% (46 of 125) of the cases showed extraprostatic extension and seminal vesicle invasion, whereas 64% cases showed lymphovascular invasion. Mean and median total tumor volumes were 6.39 and 3.92 cm, with ≥50% and ≥90% Gleason patterns 4/5 in 105 (84%) and 73 (58%) cases, respectively. Dominant lesions on radical prostatectomy were as follows: 50 right lobe, 44 left lobe, and 31 bilateral lobe tumors. Fifteen of 50 (30%) right lobe and 18 of 44 (41%) left lobe dominant tumors had LN metastasis on the contralateral side. Only 4% (5 of 125) of the cases were associated with anterior dominant tumors. Thirty percent to 40% of LN metastases occurred contralateral to the dominant tumor. LN metastasis is overwhelmingly associated with high-grade, high-stage, and large volume disease. LN positivity is rarely associated with anterior dominant tumors.

Predicting Biochemical Recurrence-Free Survival for Patients With Positive Pelvic Lymph Nodes at Radical Prostatectomy

DETECTION OF EARLY LYMPH NODE METASTASES IN PROSTATE CANCER BY LAPAROSCOPIC RADIOISOTOPE GUIDED SENTINEL LYMPH NODE DISSECTION

This study aimed to evaluate the diagnostic performance of prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT), multiparametric magnetic resonance imaging (mpMRI), prostate-specific antigen (PSA), and maximum standardized uptake value (SUVmax) in detecting seminal vesicle invasion (SVI), extraprostatic extension (EPE), and lymph node (LN) metastasis in patients undergoing radical prostatectomy for prostate cancer (PCa). A retrospective analysis was conducted on 66 patients who underwent preoperative PSMA PET/CT and radical prostatectomy between 2013 and 2024. mpMRI was available in 33 patients. Imaging findings were compared with histopathological results to assess the sensitivity, specificity, accuracy, and predictive values of PSMA PET/CT and mpMRI for detecting SVI, EPE, and LN metastasis. The relationships of PSA and SUVmax with pathological outcomes were also evaluated. PSMA PET/CT demonstrated higher sensitivity and overall accuracy than mpMRI in detecting SVI, whereas mpMRI was more specific. For EPE detection, PSMA PET/CT was more sensitive, while mpMRI was more specific. Both modalities had similar predictive values. Although SUVmax and PSA showed a positive correlation, neither parameter significantly differentiated patients with or without SVI, EPE, or LN metastases. LN uptake on PSMA PET/CT was consistent with pathology in most cases, yet no significant association was found with SUVmax or PSA levels. PSMA PET/CT is more successful in detecting SVI, whereas mpMRI is more prominent in EPE. The SUVmax value appears to be nearly significant in SVI and LN node metastasis. PSA has not shown a value for diagnosing local invasions of the prostate and LN metastases.

Identifying Node-Positive Prostate Cancer Patients Who May Benefit From Adjuvant Pelvic Radiation Following Prostatectomy

Purpose Paxillin regulates cell-cell adhesion, and altered Paxillin expression has been associated with human carcinogenesis. This study analyzed the association between Paxillin expression in prostate cancer (PCa) tissues with clinicopathological features, lymph node metastasis and biochemical PCa recurrence.Methods A total of 386 tissue specimens from PCa patients who received radical prostatectomy and 60 tissue specimens from benign prostatic hyperplasia (BPH) cases were collected to construct tissue microarrays, which were subsequently immunostained for Paxillin expression. Thirty positive lymph node tissue specimens and 10 healthy prostate tissue specimens were randomly selected for Paxillin immunostaining.Results The association between Paxillin expression, lymph node metastasis and biochemical PCa recurrence was analyzed. Paxillin expression was significantly higher in PCa than both normal and BPH tissues (P<0.001) and was correlated with preoperative prostate-specific antigen level, Gleason score, clinical tumor stage, lymph node metastasis, positive surgical margin, extracapsular extension and seminal vesicle invasion (P<0.05 for all). Logistic regression analysis showed that Paxillin and Gleason score were independent risk factors for PCa lymph node metastasis (P<0.05). The receiver operating characteristic (ROC) curve indicated that Paxillin expression (AUC=0.723) more accurately predicted PCa lymph node metastasis than Gleason score (AUC=0.692). Kaplan-Meier curve analysis showed that increased Paxillin expression was associated with shortened biochemical-free survival (BFS) after radical prostatectomy (P<0.001).Conclusion Paxillin was significantly upregulated in PCa compared with BPH and normal tissues and associated with lymph node metastasis and shortened BFS of PCa. Further study will investigate the underlying molecular mechanism and the role of Paxillin in PCa.

Aim. To investigate whether blood-based markers could be used to identify prostate cancer (PCa) patients harboring lymph node (LN) metastases. In addition, E-cadherin expression was studied within the concept of epithelial mesenchymal plasticity. Material and methods. Seventy-five patients with clinically localized PCa who underwent a superextended lymphadenectomy followed by radical prostatectomy (RP) were included in this study. Preoperative plasma/serum levels of endoglin, transforming growth factor-β1 (TGF-β1), osteopontin, vascular endothelial growth factor (VEGF), vascular cell adhesion molecule-1 (VCAM-1), and E-cadherin were measured using commercially available enzyme immunoassays in 47/75 patients and correlated with clinicopathological parameters. E-cadherin expression in the diagnostic biopsies (n = 63), RP specimens (n = 75) and LN metastases (n = 106) was examined by immunohistochemical analysis. Results. Occult LN metastases were present in almost half of the patients (37/75), with a total of 106 affected LN. Preoperative levels of endoglin, TGF-β1, osteopontin, VEGF, VCAM-1 nor E-cadherin were significantly associated with LN status. Only a positive correlation between plasma endoglin and serum prostate-specific antigen was found (Spearman's r = 0.44; p = 0.002). The majority of biopsies (91.9%) and RP specimens (79.7%) showed strong E-cadherin expression, while in the LN this was found to be much weaker (28.9%). While the staining pattern in the isolated tumor cells (ITC) and micrometastases was mainly homogenous, the macrometastases showed a much more heterogeneous pattern (χ², p < 0.0001). Conclusion. In this study, none of the blood-based markers tested could be used for nodal staging in PCa, nor could E-cadherin expression in the tissue. However, the difference in E-cadherin expression pattern between the ITC/micrometastases and the macrometastases may point to another biological behavior. The specific staining pattern seen in the macrometastases could indicate an ongoing mesenchymal epithelial transition, presumed to be a mechanism for metastatic colonization. As the latter is the rate-limiting step in the metastatic process, evaluation of the E-cadherin expression pattern could have potential therapeutic implications.

DETECTION OF MICROMETASTATIC PROSTATE CANCER CELLS IN THE LYMPH NODES BY REVERSE TRANSCRIPTASE POLYMERASE CHAIN REACTION IS PREDICTIVE OF BIOCHEMICAL RECURRENCE IN PATHOLOGICAL STAGE T2 PROSTATE CANCER.

Radical prostatectomy findings in patients with locally aggressive Grade group 5 prostatic adenocarcinoma and negative limited or extended pelvic lymph node dissection

Fusion of high B-value diffusion-weighted and T2-weighted MR images increases sensitivity for identification of extraprostatic disease in prostate cancer

Objective To evaluate the accuracy of Gallina nomogram in predicting seminal vesicle invasion (SVI) in prostate cancer.Methods From January 2009 to December 2011,89 patients with prostate carcinoma underwent open retropubic or laparoscopic radical prostatectomy.Complete data of preoperative serum prostate specific antigen (PSA),clinical stage,biopsy Gleason score,percentage of positive biopsy cores,pelvic MRI and pathological report of prostatectomy specimen were collected,and all the patients met the inclusion criteria of Gallina nomogram,2001 Partin tables and 2007 Partin tables.Postoperative pathological results were respectively compared with MRI and the incidence of SVI predicted by the three tools,and the sensitivity,specificity and accuracy of MRI in predicting SVI were calculated.The receiver operating characteristics curves were performed to test the predictive accuracy of SVI of each tool.Results The incidences of organ-confined disease,capsule invasion,SVI and lymph node metastasis were 58.4％,16.9％,22.5％,and 2.2％,respectively.The sensitivity,specificity and accuracy of MRI in predicting SVI was 45.0％ (9/20),71.0％ (49/69) and 65.2％ (58/89),respectively.The area under the curve (AUC) for SVI disease prediction of 2001 Partin tables,2007 Partin tables and Gallina nomogram was 0.712,0.711 and 0.801,respectively.Conclusions The sensitivity of MRI in predicting SVI is poor,the specificity and accuracy are common.All the predictive tools have a reasonable value for SVI (AUC ＞ 0.7),and Gallina nomogram is superior to two versions of Partin tables in predicting SVI. Key words: Prostatic neoplasms; Seminal vesicle invasion; Nomograms; Partin tables; Prediction

PD10-10 IMPROVING PREDICTION OF LOCAL STAGE BY PSMA-PET. DEVELOPMENT OF A NOVEL INTEGRATED TOOL FOR EXTRACAPSULAR EXTENSION AND SEMINAL VESICLE INVASION COMBINING CLINICAL AND IMAGING FEATURES IN LOCALIZED PROSTATE CANCER

10077 Background: Pelvic lymph node metastases are associated with a greater risk of prostate cancer recurrence and peripheral metastasis. Unfortunately, markers predictive of lymph node metastasis and/or recurrence after radical prostatectomy are limited and new molecular markers are needed to identify patients at higher risk of progression. NF-kB (p65) is a candidate molecular marker already associated with poor clinical outcomes such as biochemical recurrence and bone metastasis. We have also reported elevated nuclear p65 expression in prostate cancer lymph node metastasis. Pertinent to this issue, we tested whether the nuclear localization of p65 in radical prostatectomy specimens could predict the presence of lymph node metastases. Methods: Following informed consent, 51 patients who underwent radical prostatectomy were included in the study: 20 patients had lymph node metastasis at surgery and 31 patients had no evidence of lymph node metastasis and were used as the control group. All cases in the control group had no biochemical relapse 5 years following radical prostatectomy. NF-kB expression in prostate tumor sections was assessed by immunohistochemistry using a monoclonal NF-kB p65 antibody. The relation between nuclear p65 expression in primary tumors and lymph node metastasis was tested in univariate and multivariate Cox regression models. Results: Primary tumors of metastatic patients had an average of 21.25% of tumor cells with nuclear p65 expression as opposed to 9.42% of tumor cells of control patients (p=0.001). Univariate Cox regression demonstrated a 7.5% increased risk of having lymph node metastases for each percent increase in p65 nuclear staining (p=0.003). In the multivariate model, after controlling for pre-operative PSA (p=0.175), Gleason patterns (p=0.382), pathological stage (p=0.436), extracapsular extension (p=0.243) and seminal vesicle invasion (p=0.016), nuclear p65 was associated with an 8.8% increased risk for lymph node metastases (p=0.024). Conclusion: In univariate and multivariate analyses, p65 nuclear expression was strongly predictive of lymph node invasion. We propose that nuclear NF-kB (p65) may serve as a useful independent molecular marker for stratifying patients at risk for lymph node metastases. No significant financial relationships to disclose.

The interrelationship among localization of tumor, local extension, lymph node metastasis and various histological grades was investigated in 31 consecutive series of prostate cancer treated by radical prostatectomy. Surgical specimens were examined by step sections cut perpendicular to the urethra. Each tumor was graded histologically in accordance with WHO-Mostofi grading (evaluated by nuclear anaplasia and structural differentiation), Gleason's and M.D. Anderson's grading systems. The areas of the prostate was divided into 4 quadrants delimited vertically along the urethral axis and transversely at the level of utricle, i.e. anterior/superior, anterior/inferior, posterior/superior and posterior/inferior quadrants. Topographical localization and extension of each tumor was examined in accordance with the above area subdivision. Every tumor was growing at least in the posterior/inferior area. All cases with tumor progression to the anterior/superior area also revealed extensive tumor growth in the other two or three quadrants. Therefore, prostate cancer appears to be originated from the posterior/inferior area of the prostate and terminated in the anterior/superior area as local extension. In 31 cases examined, capsular invasion was noted in 22, seminal vesicle invasion in 16, and lymph node metastasis in 12 cases. All cases with seminal vesicle invasion also showed capsular invasion. None of the cases without capsular and/or seminal vesicle invasion had lymph node metastasis. Thus, it is inferred that prostate cancer is initially growing locally, extending to the capsule and seminal vesicle and then metastasizes to the pelvic lymph nodes. As for the histological grading, higher grade tumors tended to show higher incidence of capsular and seminal vesicle invasion and lymph node metastasis.(ABSTRACT TRUNCATED AT 250 WORDS)