Defining Prostatic Vascular Pedicle Recurrence and the Anatomy of Local Recurrence of Prostate Cancer on Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography

Dundee, Philip; Furrer, Marc A.; Corcoran, Niall M.; Peters, Justin; Pan, Henry; Ballok, Zita; Ryan, Andrew; Guerrieri, Mario; Costello, Anthony J.

doi:10.1016/j.euros.2022.05.011

Cited by 4 publications

(6 citation statements)

References 32 publications

(41 reference statements)

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“…Therefore, recurrent tumor location per se does not seem to support any difference in response to sRT, while it more likely reflects the worse prognosis of disease spread more distantly than the VUA. In a recent retrospective study on PSMA PET/CT, Dundee and colleagues [26] described the recurrence at the prostatic vascular pedicle, which includes the seminal vesicle, to be associated with a higher probability of extrapelvic disease progression (pelvic lymphnodes recurrence or pelvic bones metastasis) compared to patients with VUA recurrence, supporting our results of better bNED rates for VUA-only lesions.…”

Section: Discussionsupporting

confidence: 83%

The Prognostic Value of DCE-MRI Findings before Salvage Radiotherapy after Radical Prostatectomy

Farneti

Bottero

Faiella

et al. 2023

Cancers

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Background: To investigate the predictive role of dynamic contrast-enhanced-magnetic resonance imaging (DCE-MRI) findings before salvage radiotherapy after radical prostatectomy (RP). Methods: This retrospective study selected patients with biochemical failure (BF) after RP restaged with DCE-MRI. Patients underwent sRT in 30 fractions delivering 66–69 Gy and 73.5 Gy to the prostatic fossa and to the local failure as per DCE-MRI, respectively. Pelvic nodes were treated to 54 Gy in selected patients. The endpoint was BF after sRT. Results: In total, 236 patients were analyzed and 146 (61.9%) had presumed local failure at DCE-MRI: 54.8%, 23.8% and 21.4% were found at the vesico-urethral anastomosis (VUA), the bladder neck and the retro-vesical space, respectively. The presence of a local failure at DCE-MRI halved the risk of BF; VUA-only location and lesion volume were independently correlated with survival without evidence of biochemical failure (bNED) at multivariable analysis. For patients with VUA-only disease up to 0.4 cc, the 4-year-bNED was 94.6% (95%CI: 80.2–98.6%) as opposed to 80.9% (95%CI: 71.6–87.4%) and 73.7% (95%CI: 63.1–81.8%) for other lesions and no macrodisease, respectively. Conclusion: DCE-MRI at restaging for BF after RP provides predictive and therapeutic information. Patients with small lesions at the VUA have an excellent prognosis after sRT.

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Section: Discussionsupporting

confidence: 83%

The Prognostic Value of DCE-MRI Findings before Salvage Radiotherapy after Radical Prostatectomy

Farneti

Bottero

Faiella

et al. 2023

Cancers

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“…Positive margin rates can range between 10% and 30% from RP [11,12]. Only 18% of patients with positive margins develop biochemical recurrence [12], making the relationship between margin status and local recurrence complex and unpredictable [16]. Historically, surgical margin status was thought to be a powerful prognostic factor [12] for the development and location of local recurrences; however, there is a growing body of literature that this may not be the case and that surgical margin status is not a sole indicator of prognosis [7].…”

Section: Discussionmentioning

confidence: 99%

“…Dundee et al. [16] recently characterised a cohort of patients who had local recurrence detected on PSMA PET at the prostatic vascular pedicle. As this pelvic recurrence is distant from the anastomosis itself, Dundee et al.…”

Section: Discussionmentioning

confidence: 99%

“…As this pelvic recurrence is distant from the anastomosis itself, Dundee et al. [16] discussed the issue of targeting the visualised local recurrence only that would in turn reduce the morbidity of RT to the urethra and anastomosis. Although the detection of PSMA PET local recurrences will ensure coverage by RT volumes, Koschel et al.…”

Section: Discussionmentioning

confidence: 99%

“…Dundee et al [16] recently characterised a cohort of patients who had local recurrence detected on PSMA PET at the prostatic vascular pedicle. As this pelvic recurrence is distant from the anastomosis itself, Dundee et al[16] discussed the issue of targeting the visualised local recurrence only that would in turn reduce the morbidity of RT to the urethra and anastomosis. Although the detection of PSMA PET local recurrences will ensure coverage by RT volumes, Koschel et al[2] reported in just under 100 patients receiving18 F-DCFPyL PSMA PET for biochemical recurrence after RP, 48.4% of patients had a negative scan.…”

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confidence: 99%

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Re‐defining ¹⁸F‐DCFPyl prostate‐specific membrane antigen positron emission tomography detected local recurrence from radical prostatectomy histopathology

et al. 2023

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ObjectiveTo assess topographic concordance between the histopathological features of patients’ radical prostatectomy (RP) specimens and the location of the prostate‐specific membrane antigen positron emission tomography (PSMA PET) local recurrences, qualitatively and quantitatively.Patients and MethodsOur cohort was selected from the 100 men who received a 18F‐DCFPyL PET scan in the IMPPORT trial (Australian New Zealand Clinical Trials Registry Number: ACTRN12618001530213), a prospective non‐randomised study completed by GenesisCare Victoria. Eligibility included patients with a rising prostate‐specific antigen (PSA) level (>0.2 ng/mL) after RP and PSMA PET detected local recurrence. Histopathological parameters collated included the location of tumour, extraprostatic extension (EPE), and positive margins. Criteria for the location and ‘concordance’ between histopathological features and local recurrences were pre‐defined.ResultsA total of 24 patients were eligible; the median age was 71 years, the median PSA level was 0.37 ng/mL, and the time between RP and PSMA PET was 2.6 years. In all, 15 patients had recurrences within the vesicourethral anastomotic region and nine within the lateral surgical margins. There was 100% concordance in the left–right plane between tumour location and local recurrence, with 79% of these lesions concordant three‐dimensionally; across craniocaudal, left–right, and anterior–posterior planes. In all, 10 of the 16 (63%) patients with EPE and five of the nine patients with positive margins had three‐dimensional concordance between their pathology and their local recurrence. In quantitative assessment, 17 of the 24 patients, had local recurrences that correlated with the location of their original tumour in the craniocaudal plane.ConclusionLocal recurrence is highly concordant with the position of the tumour within the prostate. Predicting the location of local recurrence using the location of the EPE and positive margins is less helpful. Further investigation into this field, could impact surgical technique and salvage radiotherapy clinical target volume.

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Het patroon van lokaal recidief na prostatectomie op PSMA PET/CT-scan

Staal,

Noordzij,

Janssen

et al. 2024

Tijdschr Urol

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SamenvattingDeze studie onderzocht het patroon van lokaal recidief (LR) na prostatectomie met behulp van prostaatspecifieke membraanantigeen (PSMA) positronemissietomografie/computertomografie (PET/CT)-scans. In totaal werden retrospectief 103 PSMA PET/CT-scans verzameld van patiënten met verdenking op LR in negen behandelcentra. Een ervaren nucleaire geneeskundige beoordeelde de geanonimiseerde scans opnieuw en identificeerde op 83 PSMA PET/CT-scans 93 laesies als verdacht voor LR. De meest voorkomende locatie van LR (56%) was binnen 2 cm craniaal van de bulbus. Daarnaast werden 24 LR (26%) waargenomen > 2 cm craniaal van de bulbus en caudaal van de top van de symfyse. Slechts 17 LR (18%) werden craniaal van de symfyse gezien. Deze bevindingen dragen bij aan de kennis van het patroon van LR na prostatectomie en kunnen in de toekomst leiden tot gerichtere bestraling van de prostaatloge.

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Defining Prostatic Vascular Pedicle Recurrence and the Anatomy of Local Recurrence of Prostate Cancer on Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography

Cited by 4 publications

References 32 publications

The Prognostic Value of DCE-MRI Findings before Salvage Radiotherapy after Radical Prostatectomy

The Prognostic Value of DCE-MRI Findings before Salvage Radiotherapy after Radical Prostatectomy

Re‐defining ¹⁸F‐DCFPyl prostate‐specific membrane antigen positron emission tomography detected local recurrence from radical prostatectomy histopathology

Het patroon van lokaal recidief na prostatectomie op PSMA PET/CT-scan

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Defining Prostatic Vascular Pedicle Recurrence and the Anatomy of Local Recurrence of Prostate Cancer on Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography

Cited by 4 publications

References 32 publications

The Prognostic Value of DCE-MRI Findings before Salvage Radiotherapy after Radical Prostatectomy

The Prognostic Value of DCE-MRI Findings before Salvage Radiotherapy after Radical Prostatectomy

Re‐defining 18F‐DCFPyl prostate‐specific membrane antigen positron emission tomography detected local recurrence from radical prostatectomy histopathology

Het patroon van lokaal recidief na prostatectomie op PSMA PET/CT-scan

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Re‐defining ¹⁸F‐DCFPyl prostate‐specific membrane antigen positron emission tomography detected local recurrence from radical prostatectomy histopathology