PD63-02 RELIABILITY OF MODERN IMAGING STUDIES FOR DETECTION AND FINAL PATHOHISTOLOGICAL STAGE IN MEN UNDERGOING RADICAL SALVAGE PROSTATECTOMY (RSP) FOR RADIORECURRENT PROSTATE CANCER (RPC)

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy V (PD63)1 Apr 2020PD63-02 RELIABILITY OF MODERN IMAGING STUDIES FOR DETECTION AND FINAL PATHOHISTOLOGICAL STAGE IN MEN UNDERGOING RADICAL SALVAGE PROSTATECTOMY (RSP) FOR RADIORECURRENT PROSTATE CANCER (RPC) Axel Heidenreich*, Shahrokh Shariat, Jeff R. Karnes, Fahad Quhal, Patricia John, and David Pfister Axel Heidenreich*Axel Heidenreich* More articles by this author , Shahrokh ShariatShahrokh Shariat More articles by this author , Jeff R. KarnesJeff R. Karnes More articles by this author , Fahad QuhalFahad Quhal More articles by this author , Patricia JohnPatricia John More articles by this author , and David PfisterDavid Pfister More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000980.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: RPC is a biochemical diagnosis and it requires a positive prostate biopsy prior to RSP. A positive biopsy does not distinguish between locally recurrent or metastatic disease. Modern imaging studies such as multiparametric MRI (mpMRI) of the prostate and/or 68Ga-PSMA-PET/CT might be helpful to identify the best candidates for RSP. METHODS: 113 patients suspicious of rPC (Phoenix classification) underwent mpMRI prior to prostate biopsy. 50 pts also received PSMA-PET/CT as part of systemic staging prior to RSP. Results of imaging studies were compared to pathohistology of RSP and pelvic lymphadenectomy specimens. Median age was 61.2 (45-71) years and median PSA prior to RSP was 5.50 (0,2-16.7) ng/ml. mpMRI was performed on a 3.0 T scanner and high resolution axial T2-weighted and DWI sequences were acquired. For PSMA-PET/CT the mean injected activity was 180 MBq and a whole body scan was performed. Uptake in suspicious lesions was analyzed by peak and maximum standardized uptake values (SUVpeak/max). Tumor-to-background ratios were calculated for all lesions in which the liver served as reference organ. RESULTS: Detection rate of rPCA was 96.4% (109/113) and 100% for mpMRI and PSMA-PET/CT, resp. The 4 pts with negative mpMRI had pT2a-c pN0 disease with only 1-3/18-21 biopsies positive and all of them exhibited positive PSMA signals. Pathohistology of RSP specimens revealed pT2 in 90 (79.6%), pT3a/b (20.4%) in 23 and pN+ in 21 (18.6%) patients. Organ-confined and locally advanced rPC was identified correct on mpMRI in 59/90 (65.6%) and 20/23 (86.7%) pts whereas pN+ was correctly detected in 3/21 (14.3%). On PSMA-PET/CT, organ confined and locally advanced rPC were identified correctly in 15/23 (65.2%) and 18/20 (90.0%) pts whereas the detection rate of pN+ was 28.6%. on a per patient base. Sensitivity, specificity, positive and negative predictive values are listed in table 1. Presence of LNM with HR of 0.32 (95%CI 0.164-0.626; P<0.001), ADT HR of 0.274 (95%CI 0.117-0.640; p=0.003) and pT3b with HR 0.44 (95%CI 0.12-0.894, p=0.04) correlated with PFS. CONCLUSIONS: PSMA-PET/CT demonstrates a low, but higher accuracy to identify LNM at time of RSP. Since LNM are associated with a short PFS, this information should be included in the decision making process. Furthermore, both mpMRI and PSMA-PET/CT were quite accurate to predict presence of locally advanced disease with a high PPV and should be included to stage patients preoperatively. Suspicion of rPC but negative mpMRI should lead to PSMA_PET/CT which has a 100% detection rate. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1292-e1293 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Axel Heidenreich* More articles by this author Shahrokh Shariat More articles by this author Jeff R. Karnes More articles by this author Fahad Quhal More articles by this author Patricia John More articles by this author David Pfister More articles by this author Expand All Advertisement PDF downloadLoading ...