68 Ga-PSMA-11 Positron Emission Tomography/Computed Tomography for Primary Lymph Node Staging Before Radical Prostatectomy: Central Review of Imaging and Comparison with Histopathology of Extended Lymphadenectomy

• Published in: European urology focus Vol. 7; no. 2; p. 288
• Main Authors: Esen, Tarik, Falay, Okan, Tarim, Kayhan, Armutlu, Ayse, Koseoglu, Ersin, Kilic, Mert, Seymen, Hülya, Sarikaya, Ahmet Furkan, Kiremit, Murat Can, Balbay, Mevlana Derya, Canda, Abdullah Erdem, Baydar, Dilek Ertoy, Kordan, Yakup, Demirkol, Mehmet Onur, Tilki, Derya
• Format: Journal Article
• Language: English
• Published: Netherlands 01-03-2021
• Subjects: Gallium Isotopes; Gallium Radioisotopes; Humans; Lymph Node Excision; Lymph Nodes - diagnostic imaging; Male; Positron Emission Tomography Computed Tomography; Prospective Studies; Prostate; Prostatectomy; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - surgery; Retrospective Studies; Staging; Positron emission tomography/computed tomography; Prostate-specific membrane antigen; Primary staging; Prostate cancer; Lymph nodes
• ISSN: 2405-4569

Results from prospective trials have shown higher accuracy of prostate-specific membrane antigen (PSMA)-based positron emission tomography (PET)/computed tomography (CT) in detection of lymph node metastasis (LNM) compared to conventional imaging.
To evaluate the accuracy of
Ga-PSMA-11 PET/CT for LNM detection in patients undergoing radical prostatectomy (RP) and extended pelvic lymph node dissection (PLND).
Between June 2014 and November 2020, 96 patients with
Ga-PSMA PET/CT for primary staging underwent RP and extended PLND.
The results from
Ga-PSMA PET/CT were compared with histologic data from primary PLND in 96 patients. All
Ga-PSMA PET/CT scans were centrally reviewed.
Of 96 patients, 15.6% (n = 15) harbored LNMs. The median prostate-specific antigen at
Ga-PSMA PET/CT was 8.0 ng/ml (interquartile range 5.5-11.7). The majority of patients had intermediate- (52.1%) or high-risk disease (41.7%). Biopsy grade group 4 and 5 was present in 22.9% and 15.6%, respectively. The
Ga-PSMA PET/CT scans identified eight of 15 patients (53.3%) as LN-positive (true positive). The calculated per-patient sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of
Ga-PSMA PET/CT in the detection of LNM were 53.3%, 98.8%, 88.9%, 92.0%, and 91.7%, respectively. The per-patient sensitivity and specificity in the detection of LNMs larger than 2 mm were 61.5% and 98.8%, respectively. The main limitation is the retrospective design of the study.
Ga-PSMA PET/CT is accurate in lymph node staging and the results support its use for primary staging of prostate cancer.
We compared prostate-specific membrane antigen (PSMA)-based positron emission tomography (PET)/computed tomography (CT) findings with histopathology results after extended lymph node dissection and showed that it is accurate in detecting lymph node metastases. Our results support the use of PSMA PET/CT for primary staging of prostate cancer.