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Mapping prostate cancer lesions before and after unsuccessful salvage lymph node dissection using repeat PSMA PET

Introduction: The aim of this study was to analyze patterns of persistent versus recurrent or new PET lesions in a selected patient cohort with PSA persistence following salvage lymph node dissection (SLND) and pre/post procedure prostate-specific membrane antigen ligand positron emission tomography...

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Main Authors: Farolfi, Andrea (Author) , Ilhan, Harun (Author) , Gafita, Andrei (Author) , Calais, Jeremie (Author) , Barbato, Francesco (Author) , Weber, Manuel (Author) , Afshar-Oromieh, Ali (Author) , Spohn, Fabian (Author) , Wetter, Axel (Author) , Rischpler, Christoph (Author) , Hadaschik, Boris (Author) , Pianori, Davide (Author) , Fanti, Stefano (Author) , Haberkorn, Uwe (Author) , Eiber, Matthias (Author) , Herrmann, Ken (Author) , Fendler, Wolfgang Peter (Author)
Format: Article (Journal)
Language:English
Published: 2020
In: Journal of nuclear medicine
Year: 2019, Volume: 61, Issue: 7, Pages: 1037-1042
ISSN:2159-662X
DOI:10.2967/jnumed.119.235374
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.2967/jnumed.119.235374
Verlag, lizenzpflichtig, Volltext: http://jnm.snmjournals.org/content/early/2019/12/03/jnumed.119.235374
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Author Notes:Andrea Farolfi, Harun Ilhan, Andrei Gafita, Jeremie Calais, Francesco Barbato, Manuel Weber, Ali Afshar-Oromieh, Fabian Spohn, Axel Wetter, Christoph Rischpler, Boris Hadaschik, Davide Pianori, Stefano Fanti, Uwe Haberkorn, Matthias Eiber, Ken Herrmann, and Wolfgang Peter Fendler
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Summary:Introduction: The aim of this study was to analyze patterns of persistent versus recurrent or new PET lesions in a selected patient cohort with PSA persistence following salvage lymph node dissection (SLND) and pre/post procedure prostate-specific membrane antigen ligand positron emission tomography (PSMA-PET). Material and Methods: 16 patients were included in this multicenter study. Inclusion criteria were: a) PSMA-PET performed for biochemical recurrence before SLND (pre-SLND PET) and b) repeat PSMA-PET performed for persistently elevated PSA level (≥0.1 ng/mL) ≥6 weeks after SLND (post-SLND PET). Image analysis was performed by three independent nuclear medicine physicians applying the molecular imaging TNM system PROMISE. Lesions were confirmed by histopathology, presence on correlative CT/MRI/bone scan or PSA response after focal therapy. Results: post-SLND PET identified PCa-lesions in 88% (14/16) of patients with PSA persistence after SLND. Median PSA was 1.2 ng/mL (IQR, 0.6-2.8 ng/mL). Disease was confined to the pelvis in 56% of patients (9/16) and most of these men had common iliac (6/16, 38%) and internal iliac lymph node metastases (6/16, 38%). Extrapelvic disease was detected in 31% of patients (5/16). In pre- and post-SLND PET comparison, 10/16 had at least one lesion already detected at baseline (63% PET persistence); 4/16 had new lesions only (25% PET recurrence); 2 had no disease on post-SLND PET. All validated regions (11 regions in 9 patients) were true positive. 9/14 (64%) patients underwent repeat local therapies after SLND (7/14 radiotherapy, 2/14 surgery). Conclusion: SLND of pelvic nodal metastases was often not complete according to PSMA-PET. About two thirds of patients had PET positive nodal disease after SLND already seen on pre-SLND PSMA-PET. Notably, about one quarter of patients had new lesions, not detected by pre-surgical PSMA-PET.
Item Description:Published online Dec. 5, 2019
Gesehen am 17.09.2020
Physical Description:Online Resource
ISSN:2159-662X
DOI:10.2967/jnumed.119.235374

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