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You have accessJournal of UrologyProstate Cancer: Staging I (PD17)1 May 2024PD17-01 PSMA PET/CT-DETECTED MESORECTAL NODAL METASTASIS IN BIOCHEMICALLY RECURRENT PROSTATE CANCER PATIENTS Rashid K. Sayyid, Rui Bernardino, Zizo Al-Daqqaq, Raj Tiwari, Jessica Cockburn, Shagana Vijayakanthan, Yazan Qaoud, Mohamad Baker Berjaoui, Ur Metser, Alejandro Berlin, and Neil E. Fleshner Rashid K. SayyidRashid K. Sayyid , Rui BernardinoRui Bernardino , Zizo Al-DaqqaqZizo Al-Daqqaq , Raj TiwariRaj Tiwari , Jessica CockburnJessica Cockburn , Shagana VijayakanthanShagana Vijayakanthan , Yazan QaoudYazan Qaoud , Mohamad Baker BerjaouiMohamad Baker Berjaoui , Ur MetserUr Metser , Alejandro BerlinAlejandro Berlin , and Neil E. FleshnerNeil E. Fleshner View All Author Informationhttps://doi.org/10.1097/01.JU.0001010044.70939.31.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A novel observation from PSMA-PET/CTs is the detection of mesorectal lymph node (MLN) metastases. The etiology of these PCa-involved MLNs and their clinical significance remain unclear. Our objective was to determine the prevalence and predictors of MLN metastases in PCa patients undergoing a PSMA-PET/CT scan for biochemical failure. METHODS: This was a cross-sectional analysis of all PCa patients with biochemical failure following radical prostatectomy (RP) or radiotherapy (XRT) who underwent an 18F-DCFPyL-PSMA-PET/CT at The Princess Margaret Cancer Centre between December 2018 and February 2021. Study patients were prospectively enrolled in the PSMA-PET for Recurrent Prostate Cancer provincial registry. Lesions with PSMA scores ≥2 were considered positive for PCa involvement (PROMISE classification). The primary outcome was the frequency of positive MLNs. The secondary objective was to evaluate demographic, oncologic, and iatrogenic predictors of positive MLNs, using univariable/multivariable logistic regression analyses. RESULTS: The cohort included 686 patients. The primary treatment modality was an RP and XRT in 528 (77.0%) and 158 (23.0%) patients, respectively. Median PSA was 1.15 ng/ml. The median time from primary treatment to PSMA-PET/CT was 5.4 years. 384 patients (56.0%) had a positive scan. 78 (11.3%) had MLN metastasis, with 48/78 (61.5%) having MLN involvement as the only site of metastasis. Of the remaining 30 patients, 27 had concurrent nodal metastasis only. 10/78 MLN metastasis were detected on the CT component.On multivariable analysis, pT3b disease (OR=4.31, p=0.011) was significantly associated with increased odds of MLN metastasis, whereas surgical factors (RP vs XRT, performance/extent of PLND), margin positivity, and Gleason Grade were not. CONCLUSIONS: 11% of PCa patients with biochemical failure undergoing a PSM-PET/CT have MLN metastasis, with pT3b disease associated with 4.31-fold increased odds of MLN metastasis. These findings suggest alternate drainage routes for PCa cells, either via alternate lymphatic drainage from the seminal vesicles (SV) or secondary to direct extension from posteriorly located tumors invading SVs. The incidence of MLN metastasis was similar irrespective of primary treatment, suggesting this is not an iatrogenic phenomenon. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e370 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Rashid K. Sayyid More articles by this author Rui Bernardino More articles by this author Zizo Al-Daqqaq More articles by this author Raj Tiwari More articles by this author Jessica Cockburn More articles by this author Shagana Vijayakanthan More articles by this author Yazan Qaoud More articles by this author Mohamad Baker Berjaoui More articles by this author Ur Metser More articles by this author Alejandro Berlin More articles by this author Neil E. Fleshner More articles by this author Expand All Advertisement PDF downloadLoading ...
Sayyid et al. (Mon,) studied this question.