Cribriform pattern disease over‐represented in pelvic lymph node metastases identified on ⁶⁸GA PSMA‐PET/CT

Abstract

Objectives To determine whether any specific histologic subtype of prostate cancer was preferentially represented in pelvic lymph node metastases identified on 68GA‐PSMA‐PET/CT. Subjects and Methods A consecutive series of 66 men with biochemical recurrent prostate cancer was evaluated with 68GA‐PSMA‐PET/CT. Where disease was confined to pelvic lymph nodes, patients were offered salvage extended pelvic lymph node dissection. Twenty patients ultimately proceeded to extended bilateral template pelvic lymph node dissection. Lymph node positivity and the histologic subtype of apparent cancer were assessed, as was PSA response to this intervention. Results Mean PSA at time of PSMA scanning for patients undergoing lymphadenectomy was 2.49 (n = 20, range 0.21–12.0). In 16 of 20 patients, there was evidence of metastatic cribriform pattern prostate cancer in excised nodes (100% cribriform pattern in 11/16). Only four of 20 patients had no evidence of this histologic subtype of disease. PSA response was not related to the presence or proportional amount of cribriform pattern disease identified. Conclusions Cribriform pattern adenocarcinoma appears to be the histologic subtype preferentially identified in pelvic lymph nodes on 68GA‐PSMA‐PET/CT. The use of PSMA‐PET may be particularly valuable in staging of primary or biochemically recurrent prostate cancer in patients with cribriform pattern disease detected on initial biopsy or radical prostatectomy. Further research is required to further confirm the observed association.

Automated segmentation of lesions and organs at risk on [68Ga]Ga-PSMA-11 PET/CT images using self-supervised learning with Swin UNETR

“…Various factors may contribute to the DSC of 0.68 for lesions, including the limited size of training sets and significant variability in lesion size, shape, proximity to organs, and intensity of uptake. While it is possible to further categorize the tumor burden into different categories such as local, bone, and lymph node, it is essential to note that most lymph node metastases commonly occur in the pelvic region, which is known as an indicator of prognosis [ 56 , 57 ]. Future research can focus on differentiating lymph node metastases in the pelvic and extrapelvic sites (such as paraaortic, mediastinal, and interaortocaval), as well as investigating the involvement of bone metastases.…”

Shining a little light on peer review debates

“…Bolton et al 8 present an interesting observation among patients with biochemical recurrent prostate cancer imaged with PSMA PET imaging. In a small series treated with salvage lymph node dissection there was a dominant histologic subtype of cribiform pattern disease in the nodes.…”

Distant Nodes Seen on PSMA PET-CT Staging Predicts Post-Treatment Progression in Men with Newly Diagnosed Prostate Cancer—A Prospective Cohort Study

“…The introduction of PSMA PET based imaging has reshaped the diagnostic and therapeutic landscape for PCa. PSMA PET-CT (computed tomography) is now recommended in international urological guidelines [ 7 ] for primary staging and re-staging of PCa due to results demonstrating superior accuracy and less radiation compared to conventional imaging [ 8 , 9 ]. Furthermore, PSMA PET-CT also has the potential to save costs to healthcare systems [ 10 ].…”