Mp14-01 Rates and Predictors of False Node-Positive Psma-Pet in Patients Treated With Radical Prostatectomy and Extend Pelvic Lymph-Node Dissection: Results From a Large, Multi-Institutional Database

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) II (MP14)1 May 2024MP14-01 RATES AND PREDICTORS OF FALSE NODE-POSITIVE PSMA-PET IN PATIENTS TREATED WITH RADICAL PROSTATECTOMY AND EXTEND PELVIC LYMPH-NODE DISSECTION: RESULTS FROM A LARGE, MULTI-INSTITUTIONAL DATABASE Francesco Barletta, Fabrizio Dal Moro, Pawel Rajwa, Juan Gomez Rivas, Lorenzo Bianchi, Christopher Darr, Junlong Zhuang, Fabio Zattoni, Wolfgang Fendler, Giancarlo Marra, Steven Joniau, Riccardo Schiavina, Agostino Mattei, Francesco Porpiglia, Maria Picchio, Roderick van den Bergh, Shahrok Shariat, Luca Afferi, Enrico Checcucci, Arturo Chiti, Timo F.W. Soeterik, Alberto Briganti, Francesco Montorsi, and Giorgio Gandaglia Francesco BarlettaFrancesco Barletta , Fabrizio Dal MoroFabrizio Dal Moro , Pawel RajwaPawel Rajwa , Juan Gomez RivasJuan Gomez Rivas , Lorenzo BianchiLorenzo Bianchi , Christopher DarrChristopher Darr , Junlong ZhuangJunlong Zhuang , Fabio ZattoniFabio Zattoni , Wolfgang FendlerWolfgang Fendler , Giancarlo MarraGiancarlo Marra , Steven JoniauSteven Joniau , Riccardo SchiavinaRiccardo Schiavina , Agostino MatteiAgostino Mattei , Francesco PorpigliaFrancesco Porpiglia , Maria PicchioMaria Picchio , Roderick van den BerghRoderick van den Bergh , Shahrok ShariatShahrok Shariat , Luca AfferiLuca Afferi , Enrico CheccucciEnrico Checcucci , Arturo ChitiArturo Chiti , Timo F.W. SoeterikTimo F.W. Soeterik , Alberto BrigantiAlberto Briganti , Francesco MontorsiFrancesco Montorsi , and Giorgio GandagliaGiorgio Gandaglia View All Author Informationhttps://doi.org/10.1097/01.JU.0001009428.69695.82.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PSMA-PET represents the most accurate imaging technique for nodal staging in prostate cancer (PCa) patients. However, a non-negligible proportion of men with suspicious nodal lesions at PSMA-PET (miN1) are not confirmed at final pathology, with previous studies reporting heterogeneous positive predictive values (PPV), spanning from 40 to 100%. Here, we aimed to test whether the rate of false positive PET-PSMA changes according to preoperative lymph node invasion (LNI) risk. METHODS: We relied on a multi-institutional cohort of 182 miN1 patients undergoing radical prostatectomy (RP) with extended pelvic lymph node dissection (ePLND) at 10 referral centres between 2016 and 2023. A false positive was defined as miN1 PSMA-PET without LNI at final pathology. Biochemical failure (BF) was defined as a PSA ≥0.1 at 6 weeks after surgery or two consecutive PSA ≥0.2. Kaplan-Meier (KM) plots depicted biochemical failure-free rates. LNI risk was calculated with the 2012 Briganti nomogram. Logistic regression model was fitted to test the impact of LNI risk on PET-PSMA false positive rate. The resulting relationship was explored using Lowess function. RESULTS: Overall, 51 (28%) vs 128 (72%) harbored ISUP 1-3 and 4-5 PCa at biopsy, respectively. A total of 60 (33%) vs 51 (28%) 71 (39%) had 1 vs 2 vs ≥3 nodal spots at PSMA-PET. Overall, 88 (48%) patients had pN0 disease at final pathology. Patients with pN1 disease exhibited higher LNI risk (14 vs 29%, p<0.001). Of note, in KM plots patients with a false positive PSMA-PET (i.e., pN0) had higher 2-yr BF-free rates compared to pN1 patients (54 vs 24%, p=0.02). Preoperative LNI risk (OR: 0.02, 95%CI 0.01-0.2 p<0.001) was significantly associated with lower risk of false positive PSMA-PET. Lowess plot showed a non-linear correlation between LNI risk and false positive PSMA-PET, where a decrease of false positive rate from roughly 60% to 10% was observed with increasing LNI risk (Figure 1). CONCLUSIONS: A non-negligible portion of miN1 patients did not harbor LNI at final pathology. The rate of false positive PSMA-PET depends on the preoperative LNI risk. Patients with a low risk of LNI and a positive PSMA-PET should not be denied curative-intent treatment options due to the non-negligible risk of false positive findings. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e219 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Francesco Barletta More articles by this author Fabrizio Dal Moro More articles by this author Pawel Rajwa More articles by this author Juan Gomez Rivas More articles by this author Lorenzo Bianchi More articles by this author Christopher Darr More articles by this author Junlong Zhuang More articles by this author Fabio Zattoni More articles by this author Wolfgang Fendler More articles by this author Giancarlo Marra More articles by this author Steven Joniau More articles by this author Riccardo Schiavina More articles by this author Agostino Mattei More articles by this author Francesco Porpiglia More articles by this author Maria Picchio More articles by this author Roderick van den Bergh More articles by this author Shahrok Shariat More articles by this author Luca Afferi More articles by this author Enrico Checcucci More articles by this author Arturo Chiti More articles by this author Timo F.W. Soeterik More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Giorgio Gandaglia More articles by this author Expand All Advertisement PDF downloadLoading ...