(UroToday.com) The 2024 European Association of Urology (EAU) annual meeting featured a session on adverse pathology and imaging for risk assessment and local staging, and a presentation by Dr. Rui Bernardino discussing intraductal prostate cancer affinity for lymphatic-predominant metastases through 18F-DCFPyL-PSMA-PET/CT scans in pre-treatment prostate cancer patients.
Intraductal prostate cancer is linked to unfavorable oncologic outcomes, marked by distinctive cellular intrinsic pathway changes and intricate immunosuppressive microenvironments that may impact the way cancer metastasizes. As such, the aim of this study presented at EAU 2024 was to determine whether the presence of intraductal prostate cancer in prostate biopsy specimens obtained from patients before primary prostate cancer treatment is associated with a lymph node metastatic propensity in PSMA-PET/CT.
This study was a cross-sectional analysis of all prostate cancer patients undergoing a pre-treatment 18F-DCFPyL-PSMA-PET/CT between January 1, 2016, and August 2021 at The Princess Margaret Cancer Centre, Toronto, Canada. Outcomes were the presence of any metastasis in the overall cohort and presence of lymphatic versus no metastases among patients that underwent PSMA-PET/CT as prostate cancer primary staging. The associations between intraductal prostate cancer presence on the prostate biopsy and the study outcomes were evaluated using univariable and multivariable logistic regression analyses.
This analysis consisted of 120 patients, with intraductal prostate cancer and cribriform pattern observed in 55 (45.8%) and 48 (40.0%) prostate biopsies, respectively. Overall, 52 patients (43.3%) had evidence of metastasis. The baseline patient characteristics stratified by any versus no metastasis is as follows:
The presence of intraductal prostate cancer on biopsy was associated with increased odds of overall metastasis on multivariable analysis (OR 2.47, 95% CI 1.09-5.61, p = 0.03). Among the 52 patients with evidence of metastasis, 41 (78.8%) had evidence of lymphatic metastasis. Presence of intraductal prostate cancer on biopsy was associated with significantly increased odds of lymphatic metastasis versus no metastases (OR 3.03, 95% CI 1.24-7.40, p = 0.01):
Dr. Bernardino concluded his presentation discussing intraductal prostate cancer affinity for lymphatic-predominant metastases through 18F-DCFPyL-PSMA-PET/CT scans in pre-treatment prostate cancer patients with the following statements:
- The presence of intraductal prostate cancer on prostate biopsy patients undergoing 18F-DCFPyL-PSMA-PET/CT in the prestaging setting is associated with 3.03-fold increased odds of lymphatic metastases on PET/CT
- Intraductal prostate cancer may represent a strong predictor of lymph node involvement in patients with Gleason Grade Group 2 and 3 prostate cancer, which may might encompass further implications on treatment decision making
Presented by: Rui M. Bernardino, MD, University of Toronto, Princess Margaret Cancer Centre, Toronto, Canada
Written by: Zachary Klaassen, MD, MSc - Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, WellStar MCG Health, @zklaassen_md on Twitter during the 2024 European Association of Urology (EAU) annual congress, Paris, France, April 5th - April 8th, 2024