Underestimation of Positron Emission Tomography/Computerized Tomography in Assessing Tumor Burden in Prostate Cancer Nodal Recurrence: Head-to-Head Comparison of
            <sup>68</sup>
            Ga-PSMA and
            <sup>11</sup>
            C-Choline in a Large, Multi-Institutional Series of Extended Salvage Lymph Node Dissections

Fossati, Nicola; Scarcella, Simone; Gandaglia, Giorgio; Suardi, Nazareno; Robesti, Daniele; Boeri, Luca; Karnes, R. Jeffrey; Heidenreich, Axel; Pfister, David; Kretschmer, Alexander; Büchner, Alexander; Stief, Christian G.; Battaglia, Antonino; Joniau, Steven; Poppel, Hendrik Van; Osmonov, Daniar; Juenemann, Klaus‐Peter; Shariat, Shahrokh F.; Hiester, Andreas; Nini, Alessandro; Albers, Peter; Tilki, Derya; Graefen, Markus; Gill, Inderbir S.; Mottrie, Alexander; Galosi, Andrea Benedetto; Montorsi, Francesco; Briganti, Alberto

doi:10.1097/ju.0000000000000800

Cited by 35 publications

(27 citation statements)

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“…29,30 Moreover, all patients in our series were staged using conventional imaging, due to the limited availability of prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) at the time of study enrollment. [31][32][33] Indeed, several studies have demonstrated the superiority of PSMA PET/CT over conventional imaging in staging QUHAL ET AL.…”

Section: Discussionmentioning

confidence: 99%

The role of lymph node dissection in salvage radical prostatectomy for patients with radiation recurrent prostate cancer

et al. 2021

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Purpose: To examine the effect of lymph node dissection on the outcomes of patients who underwent salvage radical prostatectomy (SRP). Material and Methods:We retrospectively reviewed data from radiation-recurrent patients with prostate cancer (PCa) who underwent SRP from 2000-2016. None of the patients had clinical lymph node involvement before SRP. The effect of the number of removed lymph nodes (RLNs) and the number of positive lymph nodes (PLNs) on biochemical recurrence (BCR)-free survival, metastases free survival, and overall survival (OS) was tested in multivariable Cox regression analyses.Results: About 334 patients underwent SRP and pelvic lymph node dissection (PLND). Lymph node involvement was associated with increased risk of BCR (p < .001), metastasis (p < .001), and overall mortality (p = .006). In a multivariable Cox regression analysis, an increased number of RLNs significantly lowered the risk of BCR (hazard ratio [HR] 0.96, p = .01). In patients with positive lymph nodes, a higher number of RLNs and a lower number of PLNs were associated with improved freedom from BCR (HR 0.89, p = .001 and HR 1.34, p = .008, respectively). At a median follow-up of 23.9 months (interquartile range, 4.7-37.7), neither the number of RLNs nor the number of PLNs were associated with OS (p = .69 and p = .34, respectively). Conclusion:Pathologic lymph node involvement increased the risk of BCR, metastasis and overall mortality in radiation-recurrent PCa patients undergoing SRP. TheThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Section: Discussionmentioning

confidence: 99%

The role of lymph node dissection in salvage radical prostatectomy for patients with radiation recurrent prostate cancer

et al. 2021

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“…Though molecular imaging with Choline or PSMA PET/CT has substantially improved detection rates up to 76% for PSA values <1 ng/ml (17), we probably still underestimate the true extent of disease. In a very recent study by Fossati et al the number of positive lymph nodes found on histology exceeded the number of PET/CT positive lymph nodes (18). This effect was less pronounced for PSMA-than for Choline -PET.…”

Section: Discussionmentioning

confidence: 86%

“…In a very recent study by Fossati et al. the number of positive lymph nodes found on histology exceeded the number of PET/CT positive lymph nodes ( 18 ). This effect was less pronounced for PSMA—than for Choline—PET.…”

Section: Discussionmentioning

confidence: 94%

Combining 68Ga-PSMA-PET/CT-Directed and Elective Radiation Therapy Improves Outcome in Oligorecurrent Prostate Cancer: A Retrospective Multicenter Study

et al. 2021

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BackgroundIn case of oligo-recurrent prostate cancer (PC) following prostatectomy, 68Ga-PSMA-PET/CT can be used to detect a specific site of recurrence and to initiate metastasis-directed radiation therapy (MDT). However, large heterogeneities exist concerning doses, treatment fields and radiation techniques, with some studies reporting focal radiotherapy (RT) to PSMA-PET/CT positive lesions only and other studies using elective RT strategies. We aimed to compare oncological outcomes and toxicity between PET/CT-directed RT (PDRT) and PDRT plus elective RT (eRT; i.e. prostate bed, pelvic or paraaortal nodes) in a large retrospective multicenter study.MethodsData of 394 patients with oligo-recurrent 68Ga-PSMA-PET/CT-positive PC treated between 04/2013 and 01/2018 in six different academic institutions were evaluated. Primary endpoint was biochemical-recurrence-free survival (bRFS). bRFS was analyzed using Kaplan–Meier survival curves and log rank testing. Uni- and multivariate analyses were performed to determine influence of treatment parameters.ResultsIn 204 patients (51.8%) RT was directed only to lesions seen on 68Ga-PSMA-PET/CT (PDRT), 190 patients (48.2%) received PDRT plus eRT. PDRT plus eRT was associated with a significantly improved 3-year bRFS compared to PDRT alone (53 vs. 37%; p = 0.001) and remained an independent factor in multivariate analysis (p = 0.006, HR 0.29, 95% CI 0.12–0.68). This effect was more pronounced in the subgroup of patients who were treated with PDRT and elective prostate bed radiotherapy (ePBRT) with a 3-year bRFS of 61% versus 22% (p <0.001). Acute and late toxicity grade ≥3 was 0.8% and 3% after PDRT plus eRT versus no toxicity grade ≥3 after PDRT alone.ConclusionsIn this large cohort of patients with oligo-recurrent prostate cancer, elective irradiation of the pelvic lymphatics and the prostatic bed significantly improved bRFS when added to 68Ga-PSMA-PET/CT-guided focal radiotherapy. These findings need to be evaluated in a randomized controlled trial.

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“… Distant metastasis (any metastasis that is not local or regional) Distant metastases associated with worse OS and visceral metastases more than bone metastases [47] ; distant metastases associated with worse CSS than local metastases or nonmetastatic cancer [45] Neither older nor more recent noninvasive mPC imaging methods have been fully integrated with longitudinal precision medicine trials to date. Comparisons of digital bone scan [48] , PET CT [49] , whole-body MRI [50] , and other methods are needed. Integrated studies of these methods in trials of stereotactic ablative radiotherapy of individual metastases [51] are needed.…”

Section: Resultsmentioning

confidence: 99%

Combined Longitudinal Clinical and Autopsy Phenomic Assessment in Lethal Metastatic Prostate Cancer: Recommendations for Advancing Precision Medicine

Jasu

Tolonen

Antonarakis

et al. 2021

European Urology Open Science

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Background Systematic identification of data essential for outcome prediction in metastatic prostate cancer (mPC) would accelerate development of precision oncology. Objective To identify novel phenotypes and features associated with mPC outcome, and to identify biomarker and data requirements to be tested in future precision oncology trials. Design, setting, and participants We analyzed deep longitudinal clinical, neuroendocrine expression, and autopsy data of 33 men who died from mPC between 1995 and 2004 (PELICAN33), and related findings to mPC biomarkers reported in the literature. Intervention Thirty-three men prospectively consented to participate in an integrated clinical-molecular rapid autopsy study of mPC. Outcome measurements and statistical analysis Data exploration with correction for multiple testing and survival analysis from the time of diagnosis to time to death and time to first occurrence of severe pain as outcomes were carried out. The effect of seven complications on the modeled probability of dying within 2 yr after presenting with the complication was evaluated using logistic regression. Results and limitations Feature exploration revealed novel phenotypes related to mPC outcome. Four complications (pleural effusion, severe anemia, severe or controlled pain, and bone fracture) predict the likelihood of death within 2 yr. Men with Gleason grade group 5 cancers developed severe pain sooner than those with lower-grade tumors. Surprisingly, neuroendocrine (NE) differentiation was frequently observed in the setting of high serum prostate-specific antigen (PSA) levels (≥30 ng/ml). In 4/33 patients, no controlled (requiring analgesics) or severe pain was detected, and strikingly, 14/15 metastatic sites studied in these men did not express NE markers, suggesting an inverse relationship between NE differentiation and pain in mPC. Intracranial subdural metastasis is common (36%) and is usually clinically undetected. Categorization of “skeletal-related events” complications used in recent studies likely obscures the understanding of spinal cord compression and fracture. Early death from prostate cancer was identified in a subgroup of men with a low longitudinal PSA bandwidth. Cachexia is common (body mass index <0.89 in 24/31 patients) but limited to the last year of life. Biomarker review identified 30 categories of mPC biomarkers in need of winnowing in future trials. All findings require validation in larger cohorts, preferably alongside data from this study. Conclusions The study identified novel outcome subgroups for future validation and provides “vision for mPC precision oncology 2020–2050” draft recommendations for future data collection and biomarker studies. Patient summary To better understand variation in metastatic prostate cancer behavior, we assembled and analyzed longitudi...

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Underestimation of Positron Emission Tomography/Computerized Tomography in Assessing Tumor Burden in Prostate Cancer Nodal Recurrence: Head-to-Head Comparison of ⁶⁸ Ga-PSMA and ¹¹ C-Choline in a Large, Multi-Institutional Series of Extended Salvage Lymph Node Dissections

Cited by 35 publications

References 12 publications

The role of lymph node dissection in salvage radical prostatectomy for patients with radiation recurrent prostate cancer

The role of lymph node dissection in salvage radical prostatectomy for patients with radiation recurrent prostate cancer

Combining 68Ga-PSMA-PET/CT-Directed and Elective Radiation Therapy Improves Outcome in Oligorecurrent Prostate Cancer: A Retrospective Multicenter Study

Combined Longitudinal Clinical and Autopsy Phenomic Assessment in Lethal Metastatic Prostate Cancer: Recommendations for Advancing Precision Medicine

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Underestimation of Positron Emission Tomography/Computerized Tomography in Assessing Tumor Burden in Prostate Cancer Nodal Recurrence: Head-to-Head Comparison of 68 Ga-PSMA and 11 C-Choline in a Large, Multi-Institutional Series of Extended Salvage Lymph Node Dissections

Cited by 35 publications

References 12 publications

The role of lymph node dissection in salvage radical prostatectomy for patients with radiation recurrent prostate cancer

The role of lymph node dissection in salvage radical prostatectomy for patients with radiation recurrent prostate cancer

Combining 68Ga-PSMA-PET/CT-Directed and Elective Radiation Therapy Improves Outcome in Oligorecurrent Prostate Cancer: A Retrospective Multicenter Study

Combined Longitudinal Clinical and Autopsy Phenomic Assessment in Lethal Metastatic Prostate Cancer: Recommendations for Advancing Precision Medicine

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Underestimation of Positron Emission Tomography/Computerized Tomography in Assessing Tumor Burden in Prostate Cancer Nodal Recurrence: Head-to-Head Comparison of ⁶⁸ Ga-PSMA and ¹¹ C-Choline in a Large, Multi-Institutional Series of Extended Salvage Lymph Node Dissections