(UroToday.com) The 2023 EAU annual meeting included a session on long term control of prostate cancer, featuring a presentation by Dr. Gabriele Montefusco discussing the impact of pre-operative PSMA PET/CT for men with cN0M0 conventional imaging and lymph-node positive (pN+) prostate cancer. Up to 10% of patients with negative pre-operative conventional staging are found with pN+ prostate cancer at radical prostatectomy. New imaging modalities such as PSMA PET/CT are increasingly used as staging tools. However, their clinical impact and prognostic value remain to be quantified. Dr. Montefusco and colleagues aimed to investigate the prognostic value of pre-op PSMA PET/CT in patients with cN0M0 conventional imaging subsequently found with pN+ prostate cancer at radical prostatectomy.
The study retrospectively identified men from 2001-2021 with cN0M0 disease diagnosed on conventional imaging (CT and/or MRI, and bone scan), and subsequently diagnosed with pN+ prostate cancer at radical prostatectomy at 17 referral centers. Cases with cN+ preoperative imaging at PSMA/Choline PET/CT but cN0M0 at conventional imaging were included. The primary outcome was systemic progression, and Cox proportional hazards models were used for multivariate analysis.
There were 1,163 patients included, with 66.6% having ISUP grade ≥4 disease. Of these 1,163 men, 95 had preoperative PSMA PET/CT, with 37% having positive nodes on imaging. Post-op PSA persistence (defined as ≥0.1 ng/mL) was present in 42% of cases. Post-operative management included observation (34%), adjuvant androgen deprivation therapy (ADT) (22.7%) and adjuvant radiotherapy +/- ADT (42.8%). Over a median follow-up of 42 months, men with cN+ disease on PSMA PET/CT had an increased risk of systemic progression (52.9% vs 13.6% cN0 PSMA PET/CT vs 27% cN0 at conventional imaging only; p <0.01). Additionally, cN+ disease on PSMA-PET/CT was associated with an increased risk of systemic progression on multivariate analysis (HR 5.179, 95% CI 2.781-9.645). There was no significant association for PET-PSMA found for local progression, biochemical recurrence and overall mortality (all p >0.05). Observation as an initial management strategy instead of adjuvant treatments was related with an increased risk of distant metastases (HR 1.804, 95% CI: 1.045-3.113).
Dr. Montefusco concluded this presentation discussing the impact of pre-operative PSMA PET/CT for men with cN0M0 conventional imaging and pN+ prostate cancer with the following take-home messages:
- PSMA PET/CT cN+ patients with negative conventional imaging may have an increased risk of systemic progression after radical prostatectomy
- Further studies are needed to confirm these findings and assess the benefit from radical treatment and/or multimodal adjuvant therapy in these men
Presented by: Gabriele Montefusco, MD, San Giovanni Battista Hospital, University of Turin, Dept. of Urology, Turin, Italy
Co-Authors: Marra G.1, Rajwa P.2, Van Den Bergh R.C.N.3, Zattoni F.4, Dal Moro F.4, Magli A.5, Affentranger A.6, Grogg J.B.7, Hermanns T.8, Malkiewicz B.9, Kowalczyk K.9, Shariat S.10, Bianchi A.11, Antonelli A.11, Gallina S.11, Berchiche W.12, Cathelineau X.13, Afferi L.14, Fankhauser C.14, Mattei A.15, Scuderi S.16, Briganti A.17, Gontero P.1, Gandaglia G.17
Affiliations: 1San Giovanni Battista Hospital, University of Turin, Dept. of Urology, Turin, Italy, 2Medical University of Silesia, Dept. of Urology, Zabrze, Poland, 3St. Antonius Hospital, Dept. of Urology, Utrecht, The Netherlands, 4University of Padua, Dept. of Surgery, Oncology and Gastroenterology, Padua, Italy, 5University Hospital of Udine, Dept. of Radiation Oncology, Udine, Italy, 6Cantonal Hospital of Lucerne, Dept. of Urology, Lucerne, Switzerland, 7University of Zurich, Dept. of Urology, Zurich, Switzerland, 8University Hospital Zurich, Dept. of Urology, Zurich, Switzerland, 9Wroclaw Medical University, University Center of Excellence in Urology, Dept. of Minimally Invasive and Robotic Urology, Wroclaw, Poland, 10Comprehensive Cancer Center, Medical University of Vienna, Dept. of Urology, Vienna, Austria, 11University of Verona, Azienda Ospedaliera Universitaria Integrata, Dept. of Urology, Verona, Italy, 12Marseille North Hospital, Dept. of Urology, Marseille, France, 13Institut Mutualiste Montsouris and Université Paris Descartes, Dept. of Urology, Paris, France, 14Luzerner Kantonsspital, Dept. of Urology, Luzern, Switzerland, 15Luzerner Kantonsspital, Dept. of Urology, Lucerne, Switzerland, 16Urological Research Institute, IRCCS Ospedale San Raffaele, Division of Oncology, Unit of Urology, Milan, Italy, 17Urological Research Institute, IRCCS Ospedale San Raffaele, Unit of Oncology, Unit of Urology, Milan, Italy
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2023 European Association of Urology (EAU) Annual Meeting, Milan, IT, Fri, Mar 10 – Mon, Mar 13, 2023.