PD35-01 WHICH PATIENTS WITH CN1 DISEASE AT PET/CT ARE AFFECTED BY SYSTEMIC DISEASE? IMPLICATIONS FOR TAILORED TREATMENT APPROACHES BASED ON A LARGE MULTI-INSTITUTIONAL SERIES

Abstract

You have accessJournal of UrologyCME1 May 2022PD35-01 WHICH PATIENTS WITH CN1 DISEASE AT PET/CT ARE AFFECTED BY SYSTEMIC DISEASE? IMPLICATIONS FOR TAILORED TREATMENT APPROACHES BASED ON A LARGE MULTI-INSTITUTIONAL SERIES Elio Mazzone, Giorgio Gandaglia, Armando Stabile, Daniele Robesti, Antony Pellegrino, Andrea Necchi, Daniele Raggi, Laura Marandino, Simone Scuderi, Francesco Barletta, Vito Cucchiara, Emanuele Zaffuto, Nazareno Suardi, Shahrokh F. Shariat, Francesco Montorsi, and Alberto Briganti Elio MazzoneElio Mazzone More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Armando StabileArmando Stabile More articles by this author , Daniele RobestiDaniele Robesti More articles by this author , Antony PellegrinoAntony Pellegrino More articles by this author , Andrea NecchiAndrea Necchi More articles by this author , Daniele RaggiDaniele Raggi More articles by this author , Laura MarandinoLaura Marandino More articles by this author , Simone ScuderiSimone Scuderi More articles by this author , Francesco BarlettaFrancesco Barletta More articles by this author , Vito CucchiaraVito Cucchiara More articles by this author , Emanuele ZaffutoEmanuele Zaffuto More articles by this author , Nazareno SuardiNazareno Suardi More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002593.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The role of local therapies including radical prostatectomy (RP) in prostate cancer (PCa) patients with clinical lymphadenopathies at PET/CT has been scarcely explored. Limited data is available to identify men more likely to have non-localized disease and who may benefit from multi-modal approaches. We assessed predictors of PSA persistence in surgically managed PCa patients with clinical lymphadenopathies at PET/CT by integrating clinical, magnetic resonance imaging (MRI) and PET/CT parameters. METHODS: We identified 93 men treated with RP and extended lymph node dissection with pelvic or retroperitoneal lymphadenopathies at choline (n = 46, 49%) or PSMA (n = 47, 51%) PET/CT between 2010 and 2021 at four referral centers. The study outcome was PSA persistence, defined as a first PSA ≥0.1 ng/ml after RP. Multivariable logistic regression tested predictors of PSA persistence. Covariates were biopsy ISUP grade group (1-3 vs 4-5), MRI stage (organ-confined disease [OC] vs extracapsular extension [ECE]) and number of positive spots at PET/CT. Regression tree analyses stratified patients into risk groups based on their preoperative characteristics. RESULTS: Median number of positive spots at PET/CT was 2 (IQR 1-3). Overall, 70 (75%) and 23 (25%) men had biopsy ISUP grade 4-5 and ECE at MRI. 42 (45%) experienced PSA persistence. At multivariable analyses, ISUP grade 4-5 was the strongest predictor of PSA persistence (OR 4.12; p=0.001). At regression tree, patients were stratified in four risk group according to ISUP grade, number of positive spots and MRI stage (Fig. 1). The model had a good discrimination (AUC 77%). Clinical N1 patients with ISUP grade 4-5 and ECE at MRI had a rate of 75% of PSA persistence regardless of the number of positive spots at PET/CT, thus being likely have upfront systemic disease. CONCLUSIONS: PSA persistence is non-negligible in patients with a positive lymphnodes at preoperative PET/CT. Patients with ISUP grade 1-3, as well as patients with ISUP grade 4-5, OC disease at MRI and 1-2 positive spots at PET/CT are those where RP may achieve good oncological outcomes. Conversely, patients with high ISUP grade and ECE at MRI should be considered for integrated multi-modal approaches including systemic therapies. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e627 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elio Mazzone More articles by this author Giorgio Gandaglia More articles by this author Armando Stabile More articles by this author Daniele Robesti More articles by this author Antony Pellegrino More articles by this author Andrea Necchi More articles by this author Daniele Raggi More articles by this author Laura Marandino More articles by this author Simone Scuderi More articles by this author Francesco Barletta More articles by this author Vito Cucchiara More articles by this author Emanuele Zaffuto More articles by this author Nazareno Suardi More articles by this author Shahrokh F. Shariat More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF DownloadLoading ...