Pd17-08 Predictors of Psma Positivity at Initial Staging of Prostate Cancer

You have accessJournal of UrologyProstate Cancer: Staging I (PD17)1 May 2024PD17-08 PREDICTORS OF PSMA POSITIVITY AT INITIAL STAGING OF PROSTATE CANCER Eric Victor Li, Richard Bennett, Ashorne Mahenthiran, Austin Ho, Jonathan Aguiar, Sai Kumar, Chalairat Suk-ouichai, Clayton Neill, Zequn Sun, Hiten Patel, Edward Schaeffer, and Ashley Ross Eric Victor LiEric Victor Li , Richard BennettRichard Bennett , Ashorne MahenthiranAshorne Mahenthiran , Austin HoAustin Ho , Jonathan AguiarJonathan Aguiar , Sai KumarSai Kumar , Chalairat Suk-ouichaiChalairat Suk-ouichai , Clayton NeillClayton Neill , Zequn SunZequn Sun , Hiten PatelHiten Patel , Edward SchaefferEdward Schaeffer , and Ashley RossAshley Ross View All Author Informationhttps://doi.org/10.1097/01.JU.0001010044.70939.31.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PSMA-based imaging improves detection of metastatic disease for initial staging of men diagnosed with prostate cancer (PCa) compared to conventional imaging. We determined clinicopathological factors associated with PSMA avid nodal or distant metastatic disease. METHODS: 404 men with PCa underwent initial staging with Gallium-68 or F-18 piflufolastat (DCFPyL) PSMA PET/CT across eleven hospitals from 7/2021-12/2022. PSMA positivity was determined based on radiology reports and histopathology. Equivocal or likely benign lesions were considered negative. Patients with prior diagnosis (>6 months) of PCa (n=42) or incomplete clinical history (n=22) were excluded. Wilcoxon Rank Test, Chi square, Fishers' exact test, and univariable and multivariable logistic regression were performed. RESULTS: 103/340 patients (30.3%) had PSMA findings concerning for nodal or distant metastatic disease. Patients with positive finding were less likely to be Black, and had higher PSA, biopsy Gleason Grade Group, and NCCN risk (Table 1). PSMA positivity was observed in no patients with favorable intermediate risk PCa (n=17), 9.8% (12/123) with unfavorable intermediate risk (UIR) PCa, 29% (25/86) with high risk PCa, and 58% (66/114) with very high risk (VHR) PCa. There were significant differences comparing UIR disease with 1 vs ≥2 risk factors (4.2% vs 17%, p=0.03) and VHR disease with 1 risk vs ≥2 risk factors (49% vs 72%, p=0.01), which remained significant on multivariable analysis (Table 2). Black race was also inversely associated with PSMA positivity (OR 0.32, 95% CI 0.11, 0.82, p=0.03). CONCLUSIONS: Initial staging with PSMA PET/CT identified locoregional or metastatic disease in 30% of PCa patients. A substantial proportion of UIR risk men were N1 or M1 based on PSMA positivity, particularly those with multiple UIR features. An inverse association between PSMA positivity and Black race warrants further exploration. Limitations include possible selection bias for patients with equivocal lesions on conventional imaging and limited sampling of Black men. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e373 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Eric Victor Li More articles by this author Richard Bennett More articles by this author Ashorne Mahenthiran More articles by this author Austin Ho More articles by this author Jonathan Aguiar More articles by this author Sai Kumar More articles by this author Chalairat Suk-ouichai More articles by this author Clayton Neill More articles by this author Zequn Sun More articles by this author Hiten Patel More articles by this author Edward Schaeffer More articles by this author Ashley Ross More articles by this author Expand All Advertisement PDF downloadLoading ...