1
|
Morawitz J, Kirchner J, Lakes J, Bruckmann NM, Mamlins E, Hiester A, Aissa J, Loberg C, Schimmöller L, Arsov C, Antke C, Albers P, Antoch G, Sawicki LM. PSMA PET/CT vs. CT alone in newly diagnosed biochemical recurrence of prostate cancer after radical prostatectomy: Comparison of detection rates and therapeutic implications. Eur J Radiol 2021; 136:109556. [PMID: 33485127 DOI: 10.1016/j.ejrad.2021.109556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/10/2021] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To compare prostate specific membrane antigen (PSMA) Positron Emission Tomography/Computed Tomography (PET/CT) and computed tomography (CT) alone for the detection of biochemical recurrence of prostate cancer (PCa) and effect on treatment. METHODS This retrospective study included 59 patients with recently recorded biochemical recurrence of PCa (mean PSA 1.96 ± 1.64 ng/mL) after radical prostatectomy. Patients received PET/CT with either 68Ga-PSMA-11 (n = 36) or 18F-PSMA-1007 (n = 23). PET/CT and CT images were evaluated separately in regard to PCa lesion count, type, and localisation by two physicians. Histopathology, follow-up imaging and PSA levels after salvage irradiation served as reference standard. A McNemar test was used to compare detection rates. Changes in therapeutic approaches based on staging differences between CT alone and PET/CT were assessed in a virtual multidisciplinary tumour board. RESULTS There were 142 lesions in 50 of 59 patients. PSMA PET/CT detected 141 lesions (99.3 %) in 50 patients (84.7 %), while CT detected 72 lesions (50.7 %) in 29 patients (49.2 %). A significantly higher detection rate of PSMA PET/CT was observed on a lesion-based analysis (p < 0.0001) and on a patient based analysis (p < 0.0001). Herein, both 68Ga- and 18F-PSMA PET/CT performed significantly better than CT alone (p < 0.0001, respectively). In 9 patients (15.3 %) no relapse was detectable by either modality. All lesions detected by CT were also detected by PSMA PET/CT. In 38 patients PSMA PET/CT detected more lesions than CT alone, altering the treatment approach in 22 of these patients. CONCLUSION PSMA PET/CT is superior to CT alone in detecting biochemical recurrence in PCa patients after radical prostatectomy and offered additional therapeutic options in a substantial number of patients.
Collapse
Affiliation(s)
- J Morawitz
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Dusseldorf, Germany.
| | - J Kirchner
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Dusseldorf, Germany
| | - J Lakes
- Department of Urology, University Dusseldorf, Medical Faculty, 40225, Dusseldorf, Germany
| | - N M Bruckmann
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Dusseldorf, Germany
| | - E Mamlins
- Department of Nuclear Medicine, University Dusseldorf, Medical Faculty, 40225, Dusseldorf, Germany
| | - A Hiester
- Department of Urology, University Dusseldorf, Medical Faculty, 40225, Dusseldorf, Germany
| | - J Aissa
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Dusseldorf, Germany
| | - C Loberg
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Dusseldorf, Germany
| | - L Schimmöller
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Dusseldorf, Germany
| | - C Arsov
- Department of Urology, University Dusseldorf, Medical Faculty, 40225, Dusseldorf, Germany
| | - C Antke
- Department of Nuclear Medicine, University Dusseldorf, Medical Faculty, 40225, Dusseldorf, Germany
| | - P Albers
- Department of Urology, University Dusseldorf, Medical Faculty, 40225, Dusseldorf, Germany
| | - G Antoch
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Dusseldorf, Germany
| | - L M Sawicki
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Dusseldorf, Germany
| |
Collapse
|
2
|
Miura N, Pradere B, Mori K, Mostafaei H, Quhal F, Misrai V, D'Andrea D, Albisinni S, Papalia R, Saika T, Scarpa RM, Shariat SF, Esperto F. Metastasis-directed therapy and prostate-targeted therapy in oligometastatic prostate cancer: a systematic review. MINERVA UROL NEFROL 2020; 72:531-542. [PMID: 32550632 DOI: 10.23736/s0393-2249.20.03779-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The aim of this review was to summarize the available evidence on the role of metastasis-directed therapy (MDT) and/or prostate-targeted therapy (PTT) in the setting of oligometastatic prostate cancer (PCa). EVIDENCE ACQUISITION We searched PubMed, the Web of Science, and the Cochrane Library databases. The following keywords were used: ("prostate cancer" OR "prostate carcinoma" OR "prostate neoplasm" OR "prostate tumor") AND ("oligometastatic" OR "oligometastasis" OR "PSMA") AND ("surgery" OR "prostatectomy" OR "radical prostatectomy" OR "cytoreductive" OR "local treatment" OR "radiotherapy" OR "stereotactic" OR "stereotaxic") AND ("survival" OR "mortality"). EVIDENCE SYNTHESIS After evaluating the selection criteria, 81 studies were evaluated for our endpoints. We included 22 studies for PTT of synchronous mPCa. There have been no randomized studies on cytoreductive prostatectomy (cRP). Four prospective studies showed that cRP was feasible but did not contribute to a positive effect on overall survival (OS). Regarding PTT-radiotherapy, two randomized controlled phase 3 trials showed that OS was improved in men with a low metastatic burden. Regarding MDT of metachronous lymph node recurrence, we included 29 retrospective studies. For MDT of oligometastases, we included 30 studies. One randomized phase 2 trial showed that androgen deprivation therapy-free survival improved with stereotactic body radiation therapy compared to that with surveillance; however, benefits on OS remain unclear. CONCLUSIONS We performed a comprehensive overview of the current literature on MDT and PTT. The feasibility of MDT and PTT is supported by several retrospective studies. Nevertheless, there remains a lack of high-quality trials to prove its survival benefits. Results from ongoing prospective trials data are awaited.
Collapse
Affiliation(s)
- Noriyoshi Miura
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria -
- Department of Urology, Ehime University Graduate School of Medicine, Ehime, Japan -
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University Hospital of Tours, Tours, France
- EAU Young Urologist Office (YOU), Arnhem, the Netherlands
| | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Simone Albisinni
- Department of Urology, Erasme Hospital, University Clinics of Brussels, University of Brussels, Brussels, Belgium
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Takashi Saika
- Department of Urology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Urology, University of Jordan, Amman, Jordan
- European Association of Urology Research Foundation, Arnhem, the Netherlands
| | - Francesco Esperto
- EAU Young Urologist Office (YOU), Arnhem, the Netherlands
- Department of Urology, Campus Bio-Medico University, Rome, Italy
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- European Society of Residents in Urology (ESRU), Arnhem, the Netherlands
| |
Collapse
|
3
|
Bravi CA, Fossati N, Gandaglia G, Suardi N, Mazzone E, Robesti D, Osmonov D, Juenemann KP, Boeri L, Jeffrey Karnes R, Kretschmer A, Buchner A, Stief C, Hiester A, Nini A, Albers P, Devos G, Joniau S, Van Poppel H, Shariat SF, Heidenreich A, Pfister D, Tilki D, Graefen M, Gill IS, Mottrie A, Karakiewicz PI, Montorsi F, Briganti A. Long-term Outcomes of Salvage Lymph Node Dissection for Nodal Recurrence of Prostate Cancer After Radical Prostatectomy: Not as Good as Previously Thought. Eur Urol 2020; 78:661-669. [PMID: 32624288 DOI: 10.1016/j.eururo.2020.06.043] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/17/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Long-term outcomes of patients treated with salvage lymph node dissection (sLND) for nodal recurrence of prostate cancer (PCa) remain unknown. OBJECTIVE To investigate long-term oncological outcomes after sLND in a large multi-institutional series. DESIGN, SETTING, AND PARTICIPANTS The study included 189 patients who experienced prostate-specific antigen (PSA) rise and nodal-only recurrence after radical prostatectomy (RP) and underwent sLND at 11 tertiary referral centers between 2002 and 2011. Lymph node recurrence was documented by positron emission tomography/computed tomography (PET/CT) scan using either 11C-choline or 68Ga prostate-specific membrane antigen ligand. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome of the study was cancer-specific mortality (CSM). The secondary outcomes were overall mortality, clinical recurrence (CR), biochemical recurrence (BCR), and androgen deprivation therapy (ADT)-free survival after sLND. The probability of freedom from each outcome was calculated using Kaplan-Meier analyses. Cox regression analysis was used to predict the risk of prostate CSM after accounting for several parameters, including the use of additional treatments after sLND. RESULTS AND LIMITATIONS At long term, 110 and 163 patients experienced CR and BCR, respectively, with CR-free and BCR-free survival at 10 yr of 31% and 11%, respectively. After sLND, a total of 145 patients received ADT, with a median time to ADT of 41 mo. At a median (interquartile range) follow-up for survivors of 87 (51, 104) mo, 48 patients died. Of them, 45 died from PCa. The probabilities of freedom from cancer-specific and all-cause death at 10 yr were 66% and 64%, respectively. Similar results were obtained in sensitivity analyses in patients with pelvic-only positive PET/CT scan, as well as after excluding men on ADT at PET/CT scan and patients with PSA level at sLND higher than the 75th percentile. At multivariable analyses, patients who had PSA response after sLND (hazard ratio [HR]: 0.45; p = 0.001), and those receiving ADT within 6 mo from sLND (HR: 0.51; p = 0.010) had lower risk of death from PCa. CONCLUSIONS A third of men treated with sLND for PET-detected nodal recurrence of PCa died at long term, with PCa being the main cause of death. Salvage LND alone was associated with durable long-term outcomes in a minority of men who significantly benefited from additional treatments after surgery. Taken together, all these data argue against the use of metastasis-directed therapy alone for patients with node-only recurrent PCa. These men should instead be considered at high risk of systemic dissemination already at the time of sLND. PATIENT SUMMARY We assessed long-term outcomes of patients treated with salvage lymph node dissection (sLND) for node-recurrent prostate cancer (PCa). In contrast with prior evidence, we found that the majority of these men recurred after sLND and eventually died from PCa. A significant survival benefit associated with the administration of androgen deprivation therapy after sLND suggests that sLND should be considered part of a multimodal approach rather than an exclusive treatment strategy.
Collapse
Affiliation(s)
- Carlo A Bravi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicola Fossati
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nazareno Suardi
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Elio Mazzone
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Daniele Robesti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Daniar Osmonov
- Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Germany
| | - Klaus-Peter Juenemann
- Department of Urology and Pediatric Urology, University Hospital Schleswig Holstein, Campus Kiel, Germany
| | - Luca Boeri
- Department of Urology, Mayo Clinic, Rochester, MN, USA; Department of Urology, IRCCS Foundation Ca Granda, Maggiore Policlinico Hospital, University of Milan, Milan, Italy
| | | | | | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
| | - Christian Stief
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
| | - Andreas Hiester
- Department of Urology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Alessandro Nini
- Department of Urology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany; Department of Urology and Pediatric Urology, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Peter Albers
- Department of Urology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Gaëtan Devos
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - David Pfister
- Department of Urology, University of Cologne, Cologne, Germany
| | - Derya Tilki
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Inderbir S Gill
- USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | | | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| |
Collapse
|