Abstract
PurposeThis study was designed to investigate the prognostic role of preoperative 68Ga-PSMA-11 PET/CT in predicting biochemical recurrence (BCR) of localized prostate cancer (PCa) after radical prostatectomy (RP).MethodsA total of 77 biopsy-confirmed PCa patients with 68Ga-PSMA-11 PET/CT prior to RP were included. A PSMA-ligand PET/CT-based risk model with SUVmax, maximum diameter of the index tumor and T stage was developed for prediction of 2-year BCR using Cox regression analysis. Also, the efficacy of the developed risk model was compared with European Association of Urology risk stratification (D’Amico) and the Cancer of the Prostate Risk Assessment (CAPRA) score. C-index and calibration plot were used to assess discrimination and calibration with internal validation.ResultsWith a median follow-up of 25 months, 23 (29.9%) patients experienced BCR within 2 years after RP. Patients experienced BCR had a significant higher PSA at diagnosis (p<0.001), a higher ISUP grade of biopsy (p=0.044), as well as a higher ISUP grade (p=0.001), a higher possibility of T3 diseases (p=0.001) and positive margin (p=0.008) on postoperative pathology. SUVmax, maximum diameter of the index tumor and T stage on preoperative PSMA-ligand PET/CT were significantly associated with BCR (all p<0.01). PSMA-ligand PET/CT-based risk model had a superior discrimination (c-index 78.5%) and good calibration at internal validation. The efficacy of this model in predicting 2-year BCR after RP was better, compared with CAPRA (c-index 66.3%) and D’Amico (c-index 66.2%). The addition of the PSMA-ligand PET/CT-derived variables also improved the efficacy of the existing models in predicting 2-year BCR (C-index of 78.9% for modified CAPRA and 79.3% for modified D’Amico, respectively).ConclusionA PSMA-ligand PET/CT-based risk model showed good efficacy in predicting 2-year BCR after RP, which needed to be validated by further prospective studies.
Highlights
Radical prostatectomy (RP) is a widely adopted definitive option for men with localized prostate cancer (PCa) [1, 2]
The addition of the Prostate specific membrane antigen (PSMA)-ligand positron emission tomography/computed tomography (PET/CT)-derived variables improved the efficacy of the existing models in predicting 2-year biochemical recurrence (BCR) (C-index of 78.9% for modified Cancer of the Prostate Risk Assessment (CAPRA) and 79.3% for modified D’Amico, respectively)
A PSMA-ligand PET/CT-based risk model showed good efficacy in predicting 2-year BCR after RP, which needed to be validated by further prospective studies
Summary
Radical prostatectomy (RP) is a widely adopted definitive option for men with localized prostate cancer (PCa) [1, 2]. Up to 40% of patients experienced biochemical recurrence (BCR) after RP [3] Several clinical models, such as D’Amico risk stratification scheme [4], and the University of California, San Francisco, Cancer of the Prostate Risk Assessment (CAPRA) score, have been developed to predict BCR [5]. Preoperative variables such as prostate-specific antigen (PSA), clinical T staging, and Gleason score of systematic biopsy are used as prognostic factors in these models. Prostate specific membrane antigen (PSMA)-ligand positron emission tomography/computed tomography (PET/CT) is currently a promising technique for recurrent PCa imaging [8, 9], as well as primary staging [10, 11]. The added value of PSMA-ligand PET/CT over the pre-existing models has not been evaluated
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