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Tenbergen CJA, Fortuin AS, van Asten JJA, Veltien A, Philips BWJ, Hambrock T, Orzada S, Quick HH, Barentsz JO, Maas MC, Scheenen TWJ. The Potential of Iron Oxide Nanoparticle-Enhanced MRI at 7 T Compared With 3 T for Detecting Small Suspicious Lymph Nodes in Patients With Prostate Cancer. Invest Radiol 2024; 59:519-525. [PMID: 38157433 DOI: 10.1097/rli.0000000000001056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Accurate detection of lymph node (LN) metastases in prostate cancer (PCa) is a challenging but crucial step for disease staging. Ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI) enables distinction between healthy LNs and nodes suspicious for harboring metastases. When combined with MRI at an ultra-high magnetic field, an unprecedented spatial resolution can be exploited to visualize these LNs. PURPOSE The aim of this study was to explore USPIO-enhanced MRI at 7 T in comparison to 3 T for the detection of small suspicious LNs in the same cohort of patients with PCa. MATERIALS AND METHODS Twenty PCa patients with high-risk primary or recurrent disease were referred to our hospital for an investigational USPIO-enhanced 3 T MRI examination with ferumoxtran-10. With consent, they underwent a 7 T MRI on the same day. Three-dimensional anatomical and T2*-weighted images of both examinations were evaluated blinded, with an interval, by 2 readers who annotated LNs suspicious for metastases. Number, size, and level of suspicion (LoS) of LNs were paired within patients and compared between field strengths. RESULTS At 7 T, both readers annotated significantly more LNs compared with 3 T (474 and 284 vs 344 and 162), with 116 suspicious LNs on 7 T (range, 1-34 per patient) and 79 suspicious LNs on 3 T (range, 1-14 per patient) in 17 patients. For suspicious LNs, the median short axis diameter was 2.6 mm on 7 T (1.3-9.5 mm) and 2.8 mm for 3 T (1.7-10.4 mm, P = 0.05), with large overlap in short axis of annotated LNs between LoS groups. At 7 T, significantly more suspicious LNs had a short axis <2.5 mm compared with 3 T (44% vs 27%). Magnetic resonance imaging at 7 T provided better image quality and structure delineation and a higher LoS score for suspicious nodes. CONCLUSIONS In the same cohort of patients with PCa, more and more small LNs were detected on 7 T USPIO-enhanced MRI compared with 3 T MRI. Suspicious LNs are generally very small, and increased nodal size was not a good indication of suspicion for the presence of metastases. The high spatial resolution of USPIO-enhanced MRI at 7 T improves structure delineation and the visibility of very small suspicious LNs, potentially expanding the in vivo detection limits of pelvic LN metastases in PCa patients.
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Affiliation(s)
- Carlijn J A Tenbergen
- From the Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (C.J.A.T., A.S.F., J.J.A.v.A., A.V., B.W.J.P., T.H., J.O.B., M.C.M., T.W.J.S.); Department of Radiology, Ziekenhuis Gelderse Vallei, Ede, the Netherlands (A.S.F.); Erwin L. Hahn Institute for MR Imaging, University of Duisburg-Essen, Essen, Germany (S.O., H.H.Q., T.W.J.S.); High-Field and Hybrid MR Imaging, University Hospital Essen, Essen, Germany (S.O., H.H.Q.); and Medical Physics in Radiology, German Cancer Research Center, Heidelberg, Germany (S.O.)
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Quarta L, Mazzone E, Cannoletta D, Stabile A, Scuderi S, Barletta F, Cucchiara V, Nocera L, Pellegrino A, Robesti D, Leni R, Zaurito P, Brembilla G, De Cobelli F, Samanes Gajate AM, Picchio M, Chiti A, Montorsi F, Briganti A, Gandaglia G. Defining the optimal target-to-background ratio to identify positive lymph nodes in prostate cancer patients undergoing robot-assisted [ 99mTc]Tc-PSMA radioguided surgery: updated results and ad interim analyses of a prospective phase II study. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06789-5. [PMID: 38861182 DOI: 10.1007/s00259-024-06789-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION Prostate-specific membrane antigen radioguided surgery (PSMA-RGS) might identify lymph node invasion (LNI) in prostate cancer (PCa) patients undergoing extended pelvic lymph node dissection (ePLND). The optimal target-to-background (TtB) ratio to define RGS positivity is still unknown. MATERIALS & METHODS Ad interim analyses which focused on 30 patients with available pathological information were conducted. All patients underwent preoperative PSMA positron emission tomography (PET). 99m-Technetium-PSMA imaging and surgery ([99mTc]Tc-PSMA-I&S) was administered the day before surgery. In vivo measurements were conducted using an intraoperative gamma probe. Performance characteristics and implications associated with different TtB ratios were assessed. RESULTS Overall, 9 (30%) patients had LNI, with 22 (13%) and 80 (11%) positive regions and lymph nodes, respectively. PSMA-RGS showed uptakes in 12 (40%) vs. 7 (23%) vs. 6 (20%) patients for a TtB ratio ≥ 2 vs. ≥ 3 vs. ≥ 4. At a per-region level, sensitivity, specificity and accuracy for a TtB ratio ≥ 2 vs. ≥ 3 vs. ≥ 4 were 72%, 88% and 87% vs. 54%, 98% and 92% vs. 36%, 99% and 91%. Performing ePLND only in patients with suspicious spots at PSMA PET (n = 7) would have spared 77% ePLNDs at the cost of missing 13% (n = 3) pN1 patients. A TtB ratio ≥ 2 at RGS identified 8 (24%) suspicious areas not detected by PSMA PET, of these 5 (63%) harbored LNI, with one pN1 patient (11%) that would have been missed by PSMA PET. Adoption of a TtB ratio ≥ 2 vs. ≥ 3 vs. ≥ 4, would have allowed to spare 18 (60%) vs. 23 (77%) vs. 24 (80%) ePLNDs missing 2 (11%) vs. 3 (13%) vs. 4 (17%) pN1 patients. CONCLUSIONS PSMA-RGS using a TtB ratio ≥ 2 to identify suspicious nodes, could allow to spare > 50% ePLNDs and would identify additional pN1 patients compared to PSMA PET and higher TtB ratios.
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Affiliation(s)
- Leonardo Quarta
- Division of Oncology/Unit of Urology, Gianfranco Soldera Prostate Cancer Lab, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elio Mazzone
- Division of Oncology/Unit of Urology, Gianfranco Soldera Prostate Cancer Lab, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Donato Cannoletta
- Division of Oncology/Unit of Urology, Gianfranco Soldera Prostate Cancer Lab, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Armando Stabile
- Division of Oncology/Unit of Urology, Gianfranco Soldera Prostate Cancer Lab, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simone Scuderi
- Division of Oncology/Unit of Urology, Gianfranco Soldera Prostate Cancer Lab, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Barletta
- Division of Oncology/Unit of Urology, Gianfranco Soldera Prostate Cancer Lab, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vito Cucchiara
- Division of Oncology/Unit of Urology, Gianfranco Soldera Prostate Cancer Lab, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Nocera
- Division of Oncology/Unit of Urology, Gianfranco Soldera Prostate Cancer Lab, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antony Pellegrino
- Division of Oncology/Unit of Urology, Gianfranco Soldera Prostate Cancer Lab, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniele Robesti
- Division of Oncology/Unit of Urology, Gianfranco Soldera Prostate Cancer Lab, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Leni
- Division of Oncology/Unit of Urology, Gianfranco Soldera Prostate Cancer Lab, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Zaurito
- Division of Oncology/Unit of Urology, Gianfranco Soldera Prostate Cancer Lab, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Brembilla
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
| | | | - Maria Picchio
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
| | - Arturo Chiti
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, Gianfranco Soldera Prostate Cancer Lab, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, Gianfranco Soldera Prostate Cancer Lab, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, Gianfranco Soldera Prostate Cancer Lab, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy.
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Myers AA, Briganti A, Leibovich B, Lerner SP, Moschini M, Rouprêt M, Shariat SF, Spiess PE, Stenzl A, Taneja SS, Touijer KA, Kamat AM. Contemporary Role of Lymph Node Dissection in Genitourinary Cancers: Where Are We in 2023? Eur Urol Oncol 2024; 7:412-420. [PMID: 37980250 DOI: 10.1016/j.euo.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/16/2023] [Accepted: 10/31/2023] [Indexed: 11/20/2023]
Abstract
CONTEXT Lymphadenectomy during surgery for genitourinary malignancies has varying benefits. OBJECTIVE To review contemporary evidence on lymph node dissection in genitourinary cancers. EVIDENCE ACQUISITION We performed a collaborative review to summarize current evidence supporting lymph node dissection in urothelial, prostate, kidney, penile, and testis cancers. We present the evidence on patient selection and recommended dissection templates, and highlight knowledge gaps and ongoing areas of investigation. EVIDENCE SYNTHESIS Lymph node dissection remains the reference standard for lymph node staging. Pathologic nodal stage informs prognosis and guides adjuvant treatment. Appropriate template and patient selection are paramount to optimize outcomes and capitalize on the selective therapeutic benefits. CONCLUSIONS Accurate staging with lymphadenectomy is contingent on appropriate template selection. The cumulative benefit will depend on judicious patient selection. PATIENT SUMMARY We performed a collaborative review by a diverse group of experts in urology. We reviewed current evidence on lymph node dissection.
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Affiliation(s)
- Amanda A Myers
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alberto Briganti
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Seth P Lerner
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Marco Moschini
- Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Morgan Rouprêt
- Urology, GRC 5 Predictive Onco-Uro, AP-HP, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Philippe E Spiess
- Department of GU Oncology and Tumor Biology, Moffitt Cancer Center, Tampa, FL, USA
| | - Arnulf Stenzl
- Department of Urology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Samir S Taneja
- Department of Urology, NYU Langone Health, New York, NY, USA
| | - Karim A Touijer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Panebianco V. Prostate cancer imaging for primary detection: PSMA-PET/CT vs MRI. All that glitters is not gold. Eur Radiol 2024; 34:4014-4016. [PMID: 38165433 DOI: 10.1007/s00330-023-10547-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Sapienza/Policlinico Umberto I, Viale Regina Elena 324, 00161, Rome, Italy.
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Schilham MGM, Somford DM, Veltien A, Zamecnik P, Barentsz JO, Sedelaar MJPM, Kusters-Vandevelde HVN, Gotthardt M, Rijpkema M, Scheenen TWJ. Subnodal Correspondence of PSMA Expression and USPIO-MRI in Metastatic Pelvic Lymph Nodes in Prostate Cancer. Invest Radiol 2024; 59:458-464. [PMID: 37975702 DOI: 10.1097/rli.0000000000001046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Two advanced imaging modalities used to detect lymph node (LN) metastases in prostate cancer patients are prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography and ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI). As these modalities use different targets, a subnodal comparison is needed to interpret both their correspondence and their differences. The aim of this explorative study was to compare ex vivo 111 In-PSMA μSPECT images with high-resolution 7 T USPIO μMR images and histopathology of resected LN specimens from prostate cancer patients to assess the degree of correspondence at subnodal level. MATERIALS AND METHODS Twenty primary prostate cancer patients who underwent pelvic LN dissection were included and received USPIO contrast and 111 In-PSMA. A total of 41 LNs of interest (LNOIs) were selected for ex vivo imaging based on γ-probe detection or palpation. μSPECT and μMRI acquisition were performed immediately after resection. Overlay of μSPECT images on MR images was performed, and the level of correspondence (LoC) between μSPECT and μMR findings was assessed according to a 4-point Likert classification scheme. RESULTS Forty-one LNOIs could be matched to an LN on ex vivo μMRI. Coregistration of μSPECT and USPIO-enhanced water-selective multigradient echo MR images was successful for all 41 LNOIs. Ninety percent of the lesions showed excellent correspondence regarding the presence of metastatic tissue and affected subnodal site (LoC 4; 37/41). In only 1 of 41 LNOIs, a small metastasis was misclassified by both techniques. Three LNOIs were classified as LoC 3 (7%) and 1 LNOI as LoC 2. All LoC 2 and LoC 3 lesions had PSMA-expressing metastases on final histopathology. CONCLUSIONS Coregistration of μSPECT and USPIO-μMRI showed excellent subnodal correspondence in the majority (90%) of LNs. Ex vivo imaging may thus help localize small cancer deposits within resected LNs and could contribute to improved interpretation of in vivo imaging of LNs.
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Affiliation(s)
- Melline Gabrielle Maria Schilham
- From the Department of Medical Imaging-Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (M.G.M.S., A.V., P.Z., J.O.B., M.G., M.R., T.W.J.S.); Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, the Netherlands (D.M.S., J.P.M.S.); Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (D.M.S.); Andros Clinics, Medical Imaging, Arnhem, the Netherlands (J.O.B.); Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands (J.P.M.S.); and Department of Pathology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (H.V.N.K.-V.)
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6
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Oldan JD, Almaguel F, Voter AF, Duran A, Gafita A, Pomper MG, Hope TA, Rowe SP. PSMA-Targeted Radiopharmaceuticals for Prostate Cancer Diagnosis and Therapy. Cancer J 2024; 30:176-184. [PMID: 38753752 DOI: 10.1097/ppo.0000000000000718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
ABSTRACT Prostate cancer (PCa) is the most common noncutaneous malignancy in men. Until recent years, accurate imaging of men with newly diagnosed PCa, or recurrent or low-volume metastatic disease, was limited. Further, therapeutic options for men with advanced, metastatic, castration-resistant disease were increasingly limited as a result of increasing numbers of systemic therapies being combined in the upfront metastatic setting. The advent of urea-based, small-molecule inhibitors of prostate-specific membrane antigen (PSMA) has partially addressed those shortcomings in diagnosis and therapy of PCa. On the diagnostic side, there are multiple pivotal phase III trials with several different agents having demonstrated utility in the initial staging setting, with generally modest sensitivity but very high specificity for determining otherwise-occult pelvic nodal involvement. That latter statistic drives the utility of the scan by allowing imaging interpreters to read with very high sensitivity while maintaining a robust specificity. Other pivotal phase III trials have demonstrated high detection efficiency in patients with biochemical failure, with high positive predictive value at the lesion level, opening up possible new avenues of therapy such as metastasis-directed therapy. Beyond the diagnostic aspects of PSMA-targeted radiotracers, the same urea-based chemical scaffolds can be altered to deliver therapeutic isotopes to PCa cells that express PSMA. To date, one such agent, when combined with best standard-of-care therapy, has demonstrated an ability to improve overall survival, progression-free survival, and freedom from skeletal events relative to best standard-of-care therapy alone in men with metastatic, castration-resistant PCa who are post chemotherapy. Within the current milieu, there are a number of important future directions including the use of artificial intelligence to better leverage diagnostic findings, further medicinal chemistry refinements to the urea-based structure that may allow improved tumor targeting and decreased toxicities, and the incorporation of new radionuclides that may better balance efficacy with toxicities than those nuclides that are available.
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Affiliation(s)
- Jorge D Oldan
- From the Department of Radiology, University of North Carolina, Chapel Hill, NC
| | - Frankis Almaguel
- Department of Radiology, Loma Linda University School of Medicine, Loma Linda, CA
| | - Andrew F Voter
- The Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alfonso Duran
- Department of Radiology, Loma Linda University School of Medicine, Loma Linda, CA
| | - Andrei Gafita
- The Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Martin G Pomper
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Steven P Rowe
- From the Department of Radiology, University of North Carolina, Chapel Hill, NC
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Lv Z, Song L, Wang M, Hou H, Li H, Wang X, Wang J, Wang J, Liu M. 18 F-prostate specific membrane antigen positron emission tomography/computerized tomography for lymph node staging in medium/high risk prostate cancer: A systematic review and meta-analysis. Chin Med J (Engl) 2024; 137:949-958. [PMID: 37690993 PMCID: PMC11046020 DOI: 10.1097/cm9.0000000000002850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Lymph node staging of prostate cancer (PCa) is important for planning and monitoring of treatment. 18 F-prostate specific membrane antigen positron emission tomography/computerized tomography ( 18 F-PSMA PET/CT) has several advantages over 68 Ga-PSMA PET/CT, but its diagnostic value requires further investigation. This meta-analysis focused on establishing the diagnostic utility of 18 F-PSMA PET/CT for lymph node staging in medium/high-risk PCa. METHODS We searched the EMBASE, PubMed, Cochrane library, and Web of Science databases from inception to October 1, 2022. Prostate cancer, 18 F, lymph node, PSMA, and PET/CT were used as search terms and the language was limited to English. We additionally performed a manual search using the reference lists of key articles. Patients and study characteristics were extracted and the QUADAS-2 tool was employed to evaluate the quality of included studies. Sensitivity, specificity, the positive and negative likelihood ratio (PLR and NLR), diagnostic odds ratio (DOR), area under the curve (AUC), and 95% confidence interval (CI) were used to evaluate the diagnostic value of 18 F-PSMA PET/CT. Stata 17 software was employed for calculation and statistical analyses. RESULTS A total of eight diagnostic tests including 734 individual samples and 6346 lymph nodes were included in this meta-analysis. At the patient level, the results of each consolidated summary were as follows: sensitivity of 0.57 (95% CI 0.39-0.73), specificity of 0.95 (95% CI 0.92-0.97), PLR of 11.2 (95% CI 6.6-19.0), NLR of 0.46 (95% CI 0.31-0.68), DOR of 25 (95% CI 11-54), and AUC of 0.94 (95% CI 0.92-0.96). At the lesion level, the results of each consolidated summary were as follows: sensitivity of 0.40 (95% CI 0.21-0.62), specificity of 0.99 (95% CI 0.95-1.00), PLR of 40.0 (95% CI 9.1-176.3), NLR of 0.61 (95% CI 0.42-0.87), DOR of 66 (95% CI 14-311), and AUC of 0.86 (95% CI 0.83-0.89). CONCLUSIONS 18 F-PSMA PET/CT showed moderate sensitivity but high specificity in lymph node staging of medium/high-risk PCa. The diagnostic efficacy was almost equivalent to that reported for 68 Ga-PSMA PET/CT. REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO), No. CRD42023391101.
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Affiliation(s)
- Zhengtong Lv
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Liuqi Song
- Peking University Fifth School of Clinical Medicine, Beijing 100730, China
| | - Miao Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Huimin Hou
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Haodong Li
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China
| | - Xuan Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jianye Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jianlong Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ming Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
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8
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Marra G, Rajwa P, Filippini C, Ploussard G, Montefusco G, Puche-Sanz I, Olivier J, Zattoni F, Moro FD, Magli A, Dariane C, Affentranger A, Grogg JB, Hermanns T, Chiu PK, Malkiewicz B, Kowalczyk K, Van den Bergh RCN, Shariat SF, Bianchi A, Antonelli A, Gallina S, Berchiche W, Sanchez-Salas R, Cathelineau X, Afferi L, Fankhauser CD, Mattei A, Karnes RJ, Scuderi S, Montorsi F, Briganti A, Deandreis D, Gontero P, Gandaglia G. The Prognostic Role of Preoperative PSMA PET/CT in cN0M0 pN+ Prostate Cancer: A Multicenter Study. Clin Genitourin Cancer 2024; 22:244-251. [PMID: 38155081 DOI: 10.1016/j.clgc.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/30/2023]
Abstract
CONTEXT Despite negative preoperative conventional imaging, up to 10% of patients with prostate cancer (PCa) harbor lymph-node involvement (LNI) at radical prostatectomy (RP). The advent of more accurate imaging modalities such as PET/CT improved the detection of LNI. However, their clinical impact and prognostic value are still unclear. We aimed to investigate the prognostic value of preoperative PET/CT in patients node positive (pN+) at RP. EVIDENCE SYNTHESIS We retrospectively identified cN0M0 patients at conventional imaging (CT and/or MRI, and bone scan) who had pN+ PCa at RP at 17 referral centers. Patients with cN+ at PSMA/Choline PET/CT but cN0M0 at conventional imaging were also included. Systemic progression/recurrence was the primary outcome; Cox proportional hazards models were used for multivariate analysis. EVIDENCE ACQUISITION We included 1163 pN+ men out of whom 95 and 100 had preoperative PSMA and/or Choline PET/CT, respectively. ISUP grade ≥4 was detected in 66.6%. Overall, 42% of patients had postoperative PSA persistence (≥0.1 ng/mL). Postoperative management included initial observation (34%), ADT (22.7%) and adjuvant RT+/-ADT (42.8%). Median follow-up was 42 months. Patients with cN+ on PSMA PET/CT had an increased risk of systemic progression (52.9% vs. 13.6% cN0 PSMA PET/CT vs. 21.5% cN0 at conventional imaging; P < .01). This held true at multivariable analysis: (HR 6.184, 95% CI: 3.386-11-295; P < .001) whilst no significant results were highlighted for Choline PET/CT. No significant associations for both PET types were found for local progression, BCR, and overall mortality (all P > .05). Observation as an initial management strategy instead of adjuvant treatments was related with an increased risk of metastases (HR 1.808; 95% CI: 1.069-3.058; P < .05). CONCLUSIONS PSMA PET/CT cN+ patients with negative conventional imaging have an increased risk of systemic progression after RP compared to their counterparts with cN0M0 disease both at conventional and/or molecular imaging.
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Affiliation(s)
- Giancarlo Marra
- Division of Urology, Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy.
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Medical University of Silesia, Zabrze, Poland
| | - Claudia Filippini
- Division of Urology, Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | | | - Gabriele Montefusco
- Division of Urology, Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Ignacio Puche-Sanz
- Department of Urology, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | | | - Fabio Zattoni
- Department of Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy
| | - Fabrizio Dal Moro
- Department of Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy
| | - Alessandro Magli
- Dipartimento di Radioterapia Oncologica, Ospedale Santa Maria della misericordia, Udine, Italia
| | - Charles Dariane
- Department of Urology, Hôpital européen Georges-Pompidou, Université de Paris, Paris, France
| | | | | | | | - Peter K Chiu
- Division of Urology, Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Bartosz Malkiewicz
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology Wroclaw Medical University, Wroclaw, Poland
| | - Kamil Kowalczyk
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology Wroclaw Medical University, Wroclaw, Poland
| | | | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Alberto Bianchi
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Sebastian Gallina
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - William Berchiche
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Rafael Sanchez-Salas
- Department of Surgery, Division of Urology, McGill University, Montreal, Quebec, Canada
| | | | - Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Simone Scuderi
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Désirée Deandreis
- Division of Nuclear Medicine, Department of Medical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
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9
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Baas DJH, de Baaij JMS, Sedelaar JPM, Hoekstra RJ, Vrijhof HJEJ, Somford DM, van Basten JPA. Extended pelvic lymph node dissection in robot-assisted radical prostatectomy is an independent risk factor for major complications. J Robot Surg 2024; 18:140. [PMID: 38554195 DOI: 10.1007/s11701-024-01881-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/20/2024] [Indexed: 04/01/2024]
Abstract
The aim of this study is to evaluate the major postoperative complication rate after robot-assisted radical prostatectomy (RARP) and to identify related risk factors. A consecutive series of patients who underwent RARP between September 2016 and May 2021, with or without extended pelvic lymph node dissection (ePLND) were analyzed for postoperative complications that occurred within 30 days following surgery. Potential risk factors related to complications were identified by means of a multivariate logistic analysis. Electronic medical records were retrospectively reviewed for the occurrence of major complications (Clavien-Dindo grade III or higher) on a per patient level. A multivariate logistic regression with risk factors was performed to identify contributors to complications. In total, 1280 patients were included, of whom 79 (6.2%) experienced at least 1 major complication. Concomitant ePLND was performed in 609 (48%) of patients. The majority of all complications were likely related to the surgical procedure, with anastomotic leakage and lymphoceles being the most common. Upon multivariate analysis, performing ePLND remained the only significant risk factor for the occurrence of major complications (OR 2.26, p = 0.001). In contrast to robot-assisted radical prostatectomy alone, the combination with extended pelvic lymph node dissection (ePLND) has a substantial risk of serious complications. Since the ePLND is performed mainly for staging purpose, the clinical contribution of the ePLND has to be reconsidered with the present use of the PSMA-PET/CT.
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Affiliation(s)
- Diederik J H Baas
- Department of Urology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands.
- Prosper Prostate Cancer Clinics, Nijmegen, The Netherlands.
| | - Joost M S de Baaij
- Department of Urology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands
- Prosper Prostate Cancer Clinics, Nijmegen, The Netherlands
| | - J P Michiel Sedelaar
- Prosper Prostate Cancer Clinics, Nijmegen, The Netherlands
- Department of Urology, Radboud UMC, Nijmegen, The Netherlands
| | - Robert J Hoekstra
- Prosper Prostate Cancer Clinics, Nijmegen, The Netherlands
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| | - Henricus J E J Vrijhof
- Prosper Prostate Cancer Clinics, Nijmegen, The Netherlands
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| | - Diederik M Somford
- Department of Urology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands
- Prosper Prostate Cancer Clinics, Nijmegen, The Netherlands
| | - Jean-Paul A van Basten
- Department of Urology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands
- Prosper Prostate Cancer Clinics, Nijmegen, The Netherlands
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10
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Sofia L, Bauckneht M. PSMA PET/CT in the low- to intermediate-risk prostate cancer: when and why? Asian J Androl 2024:00129336-990000000-00171. [PMID: 38534099 DOI: 10.4103/aja20244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/28/2024] [Indexed: 03/28/2024] Open
Affiliation(s)
- Luca Sofia
- Department of Health Sciences (DISSAL), University of Genova, Genova 16132, Italy
| | - Matteo Bauckneht
- Department of Health Sciences (DISSAL), University of Genova, Genova 16132, Italy
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova 16132, Italy
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11
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Roberts MJ, Yaxley JW, Stranne J, van Oort IM, Tilki D. Is extended pelvic lymph node dissection REALLY required for staging of prostate cancer in the PSMA-PET era? Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00821-3. [PMID: 38519802 DOI: 10.1038/s41391-024-00821-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/04/2024] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Matthew J Roberts
- Royal Brisbane and Women's Hospital, Department of Urology, Brisbane, QLD, Australia.
- The University of Queensland, UQ Centre for Clinical Research, Brisbane, QLD, Australia.
- The University of Queensland, Faculty of Medicine, Brisbane, QLD, Australia.
| | - John W Yaxley
- Royal Brisbane and Women's Hospital, Department of Urology, Brisbane, QLD, Australia
- The University of Queensland, Faculty of Medicine, Brisbane, QLD, Australia
- The Wesley Hospital, Brisbane, QLD, Australia
| | - Johan Stranne
- Department of Urology, Institute of Clinical Science, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Inge M van Oort
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, Koc University Hospital, Istanbul, Turkey
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12
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Deka H, Pooleri GK, Suguna B, Rajeshkannan R, Sekhar R, Bindhu MR, Prasad V. Comparison of Ga-PSMA PET MRI with mpMRI in localization and regional staging of prostate cancer. World J Urol 2024; 42:153. [PMID: 38483621 DOI: 10.1007/s00345-024-04873-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 10/28/2023] [Indexed: 03/19/2024] Open
Abstract
PURPOSE To compare diagnostic accuracy in localization and detection of extraprostatic extension (EPE), seminal vesicle invasion (SVI), lymph node involvement (LNI) between PSMA PET MRI and multiparametric MRI (mpMRI) in carcinoma prostate. METHODS We did a prospective study of consecutive men with biopsy-proven prostate cancer who underwent radical prostatectomy between July'2020 and Dec'2021 at our institution. Patients underwent PSMA PET MRI imaging. MpMRI findings were inferred separately by another radiologist who was blinded to the PSMA PET findings. PIRADS > 2 and any standardized uptake value (SUV) were considered positive. Findings were mapped to a 30-region anatomical grid and compared with pathology. The uro-pathologist also marked the presence of the tumor onto the same anatomical grid. The presence of EPE, SVI, and LVI was noted. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The significance in difference: McNemar test. SUVmax and Gleason score: Kruskal-Wallis test. RESULTS Seventy-five men (mean age 65) with an average PSA of 21.5 ng/ml were included. The sensitivity of PSMA PET MRI for localization was higher [63.6 vs 41.9] (p < 0.001) while specificity was similar [81.5 vs 83.2] (p 0.103). The former had a higher sensitivity to detect SVI [85.7 vs 57.10] (p = 0.03). No difference in the detection of EPE or LNI was noted. SUVmax > 7 was associated with high-risk disease (Gleason score >/= 7). LIMITATIONS non-randomized nature, higher risk population. CONCLUSION Ga-PSMA PET MRI improved the localization of prostate cancer and better detection of SVI. Further studies are required. It can act as a single-stop investigation for the primary staging of prostate cancer.
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Affiliation(s)
- Hiranya Deka
- Urology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | | | | | | | - Resmi Sekhar
- Radiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - M R Bindhu
- Pathology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Vishnu Prasad
- Amrita Institute of Medical Sciences, B-1402, Confident Pride, Vattekunnam Road, Edapally, Kochi, Kerala, 682024, India.
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13
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Schilham MGM, Somford DM, Küsters-Vandevelde HVN, Hermsen R, van Basten JPA, Hoekstra RJ, Scheenen TWJ, Gotthardt M, Sedelaar JPM, Rijpkema M. Prostate-Specific Membrane Antigen-Targeted Radioguided Pelvic Lymph Node Dissection in Newly Diagnosed Prostate Cancer Patients with a Suspicion of Locoregional Lymph Node Metastases: The DETECT Trial. J Nucl Med 2024; 65:423-429. [PMID: 38176721 DOI: 10.2967/jnumed.123.266495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 01/06/2024] Open
Abstract
Prostate-specific membrane antigen (PSMA)-targeted radioguided surgery (RGS) aims to optimize the peroperative detection and removal of PSMA-avid lymph node (LN) metastases (LNMs) and has been described in patients with recurrent prostate cancer (PCa). In newly diagnosed PCa patients undergoing pelvic LN dissections, PSMA RGS could guide the urologist toward PSMA-expressing LNMs as identified on preoperative 18F-PSMA PET/CT imaging. The objective was to evaluate the safety and feasibility of 111In-PSMA RGS in primary PCa patients with one or more suggestive LNs on preoperative 18F-PSMA PET/CT. Methods: This prospective, phase I/II study included 20 newly diagnosed PCa patients with at least 1 suggestive LN on preoperative 18F-PSMA PET/CT. PSMA RGS was performed 24 h after 111In-PSMA-I&T administration, and postoperative 18F-PSMA PET/CT was performed to verify successful removal of the suggestive lesions. The primary endpoint was determination of the safety and feasibility of 111In-PSMA RGS. Safety was assessed by monitoring adverse events. Feasibility was described as the possibility to peroperatively detect suggestive LNs as identified on preoperative imaging. Secondary outcomes included the accuracy of 111In-PSMA RGS compared with histopathology, tumor- and lesion-to-background ratios, and biochemical recurrence. Results: No tracer-related adverse events were reported. In 20 patients, 43 of 49 (88%) 18F-PSMA PET-suggestive lesions were successfully removed. 111In-PSMA RGS facilitated peroperative identification and resection of 29 of 49 (59%) RGS-target lesions, of which 28 (97%) contained LNMs. Another 14 of 49 (29%) resected LNs were not detected with 111In-PSMA RGS, of which 2 contained metastases. Conclusion: 111In-PSMA RGS is a safe and feasible procedure that allows peroperative detection of 18F-PSMA PET/CT-suggestive lesions in newly diagnosed PCa patients. The use of a radioactive PSMA tracer and a detection device (γ-probe) during surgery helps in identifying LNs that were suggestive of PCa metastases on the 18F-PSMA PET/CT before surgery and thus may improve the peroperative identification and removal of these LNs.
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Affiliation(s)
- Melline G M Schilham
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands;
- Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Diederik M Somford
- Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Rick Hermsen
- Department of Nuclear Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Jean Paul A van Basten
- Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Robert J Hoekstra
- Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands; and
| | - Tom W J Scheenen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J P Michiel Sedelaar
- Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark Rijpkema
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
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14
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Ding G, Tang G, Wang T, Zou Q, Cui Y, Wu J. A comparative analysis of perioperative complications and biochemical recurrence between standard and extended pelvic lymph node dissection in prostate cancer patients undergoing radical prostatectomy: a systematic review and meta-analysis. Int J Surg 2024; 110:1735-1743. [PMID: 38052016 PMCID: PMC10942186 DOI: 10.1097/js9.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Pelvic lymph node dissection (PLND) is commonly performed during radical prostatectomy (RP) for prostate cancer staging. This study aimed to comprehensively analyze existing evidence compare perioperative complications associated with standard (sPLND) versus extended PLND templates (ePLND) in RP patients. METHODS A meta-analysis of prospective studies on PLND complications was conducted. Systematic searches were performed on Web of Science, Pubmed, Embase, and the Cochrane Library until May 2023. Risk ratios (RRs) were estimated using random-effects models in the meta-analysis. The statistical analysis of the data was carried out using Review Manager software. RESULTS Nine studies, including three randomized clinical trial and six prospective studies, with a total of 4962 patients were analyzed. The meta-analysis revealed that patients undergoing ePLND had a higher risk of partial perioperative complications, such as lymphedema ( I2 =28%; RR 0.05; 95% CI: 0.01-0.27; P <0.001) and urinary retention ( I2 =0%; RR 0.30; 95% CI: 0.09-0.94; P =0.04) compared to those undergoing sPLND. However, there were no significant difference was observed in pelvic hematoma ( I2 =0%; RR 1.65; 95% CI: 0.44-6.17; P =0.46), thromboembolic ( I2 =57%; RR 0.91; 95% CI: 0.35-2.38; P =0.85), ureteral injury ( I2 =33%; RR 0.28; 95% CI: 0.05-1.52; P =0.14), intraoperative bowel injury ( I2 =0%; RR 0.87; 95% CI: 0.14-5.27; P =0.88), and lymphocele ( I2 =0%; RR 1.58; 95% CI: 0.54-4.60; P =0.40) between sPLND and ePLND. Additionally, no significant difference was observed in overall perioperative complications ( I2 =85%; RR 0.68; 95% CI: 0.40-1.16; P =0.16). Furthermore, ePLND did not significantly reduce biochemical recurrence ( I2 =68%; RR 0.59; 95% CI: 0.28-1.24; P =0.16) of prostate cancer. CONCLUSION This analysis found no significant differences in overall perioperative complications or biochemical recurrence between sPLND and ePLND, but ePLND may offer enhanced diagnostic advantages by increasing the detection rate of lymph node metastasis.
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Affiliation(s)
| | | | | | | | - Yuanshan Cui
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, People’s Republic of China
| | - Jitao Wu
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, People’s Republic of China
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15
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Neuberger M, Kowalewski KF, Simon V, von Hardenberg J, Siegel F, Wessels F, Worst TS, Michel MS, Westhoff N, Kriegmair MC, Honeck P, Nuhn P. Peritoneal Flap for Lymphocele Prophylaxis Following Robotic-assisted Radical Prostatectomy with Lymph Node Dissection: The Randomised Controlled Phase 3 PELYCAN Trial. Eur Urol Oncol 2024; 7:53-62. [PMID: 37543465 DOI: 10.1016/j.euo.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/14/2023] [Accepted: 07/12/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Symptomatic lymphoceles (SLCs) after transperitoneal robotic-assisted radical prostatectomy with pelvic lymph node dissection (PLND) are common. Evidence from randomised controlled trials (RCTs) on the impact of peritoneal flaps (PFs) on lymphocele (LC) reduction is inconclusive. OBJECTIVE To show that addition of PFs leads to a reduction of postoperative SLCs. DESIGN, SETTING, AND PARTICIPANTS An investigator-initiated, prospective, parallel, double-blinded, adaptive, phase 3 RCT was conducted. Recruitment took place from September 2019 until December 2021; 6-month written survey-based follow-up was recorded. Stratification was carried out according to potential LC risk factors (extended PLND, diabetes mellitus, and anticoagulation) and surgeons; 1:1 block randomisation was used. Surgeons were informed about allocation after completion of the last surgical step. INTERVENTION To create PFs, the ventral peritoneum was incised bilaterally and fixated to the pelvic floor. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was SLCs. Secondary endpoints included asymptomatic lymphoceles (ALCs), perioperative parameters, and postoperative complications. RESULTS AND LIMITATIONS In total, 860 men were screened and 551 randomised. Significant reductions of SLCs (from 9.1% to 3.7%, p = 0.005) and ALCs (27.2% to 10.3%, p < 0.001) over the follow-up period of 6 mo were observed in the intention-to-treat analysis. Operating time was 11 min longer (p < 0.001) in the intervention group; no significant differences in amount (80 vs 103, p = 0.879) and severity (p = 0.182) of postoperative complications (excluding LCs) were observed. The survey-based follow-up might be a limitation. CONCLUSIONS This is the largest RCT evaluating PF creation for LC prevention and met its primary endpoint, the reduction of SLCs. The results were consistent among all subgroup analyses including ALCs. Owing to the subsequent reduction of burden for patients and the healthcare system, establishing PFs should become the new standard of care. PATIENT SUMMARY A new technique-creation of bilateral peritoneal flaps-was added to the standard procedure of robotic-assisted prostatectomy for lymph node removal. It was safe and decreased lymphocele development, a common postoperative complication and morbidity. Hence, it should become a standard procedure.
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Affiliation(s)
- Manuel Neuberger
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Karl-Friedrich Kowalewski
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Valentin Simon
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jost von Hardenberg
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Fabian Siegel
- Department of Biomedical Informatics, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frederik Wessels
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Thomas S Worst
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maurice Stephan Michel
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Niklas Westhoff
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maximilian C Kriegmair
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Patrick Honeck
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philipp Nuhn
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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16
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Falkenbach F, Kachanov M, Leyh-Bannurah SR, Maurer T, Knipper S, Köhler D, Graefen M, Sauter G, Budäus L. Size of lymph-node metastases in prostate cancer patients undergoing radical prostatectomy: implication for imaging and oncologic follow-up of 2705 lymph-node positive patients. World J Urol 2024; 42:38. [PMID: 38244095 PMCID: PMC10799788 DOI: 10.1007/s00345-023-04724-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/28/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Despite modern imaging modalities, lymph-node staging before radical prostatectomy (RP) remains challenging in patients with prostate cancer (PCa). The visibility of lymph-node metastases (LNMs) is critically influenced by their size. OBJECTIVE This study aims to describe the distribution of maximal tumor diameters (i.e., size) in LNMs of pN1-PCa at RP and its consequences on visibility in preoperative imaging and oncological outcomes. DESIGN, SETTING, AND PARTICIPANTS A total of 2705 consecutive patients with pN1-PCa at RP, harboring a cumulative 7510 LNMs, were analyzed. Descriptive and multivariable analyses addressed the risk of micrometastases (MM)-only disease and the visibility of LNMs. Kaplan-Meier curves and Cox analyses were used for biochemical recurrence-free survival (BCRFS) stratified for MM-only disease. RESULTS The median LNM size was 4.5mm (interquartile range (IQR): 2.0-9.0 mm). Of 7510 LNMs, 1966 (26%) were MM (≤ 2mm). On preoperative imaging, 526 patients (19%) showed suspicious findings (PSMA-PET/CT: 169/344, 49%). In multivariable analysis, prostate-specific antigen (PSA) (OR 0.98), age (OR 1.01), a Gleason score greater than 7 at biopsy (OR 0.73), percentage of positive cores at biopsy (OR 0.36), and neoadjuvant treatment (OR 0.51) emerged as independent predictors for less MM-only disease (p < 0.05). Patients with MM-only disease compared to those harboring larger LNMs had a longer BCRFS (median 60 versus 29 months, p < 0.0001). CONCLUSION Overall, 26% of LNMs were MM (≤ 2mm). Adverse clinical parameters were inversely associated with MM at RP. Consequently, PSMA-PET/CT did not detect a substantial proportion of LNMs. LNM size and count are relevant for prognosis.
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Affiliation(s)
- Fabian Falkenbach
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Mykyta Kachanov
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sami-Ramzi Leyh-Bannurah
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Tobias Maurer
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sophie Knipper
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Daniel Köhler
- Department for Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Guido Sauter
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Budäus
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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17
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Vidal-Sicart S, Goñi E, Cebrecos I, Rioja ME, Perissinotti A, Sampol C, Vidal O, Saavedra-Pérez D, Ferrer A, Martí C, Ferrer Rebolleda J, García Velloso MJ, Orozco-Cortés J, Díaz-Feijóo B, Niñerola-Baizán A, Valdés Olmos RA. Continuous innovation in precision radio-guided surgery. Rev Esp Med Nucl Imagen Mol 2024; 43:39-54. [PMID: 37963516 DOI: 10.1016/j.remnie.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/26/2023] [Indexed: 11/16/2023]
Abstract
Since its origins, nuclear medicine has faced technological changes that led to modifying operating modes and adapting protocols. In the field of radioguided surgery, the incorporation of preoperative scintigraphic imaging and intraoperative detection with the gamma probe provided a definitive boost to sentinel lymph node biopsy to become a standard procedure for melanoma and breast cancer. The various technological innovations and consequent adaptation of protocols come together in the coexistence of the disruptive and the gradual. As obvious examples we have the introduction of SPECT/CT in the preoperative field and Drop-in probes in the intraoperative field. Other innovative aspects with possible application in radio-guided surgery are based on the application of artificial intelligence, navigation and telecare.
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Affiliation(s)
- Sergi Vidal-Sicart
- Servicio de Medicina Nuclear, Hospital Clínic Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Elena Goñi
- Servicio de Medicina Nuclear, Hospital Universitario de Navarra, Pamplona, Spain
| | - Isaac Cebrecos
- Instituto Clínic de Ginecología, Obstetricia y Neonatología (ICGON), Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Andrés Perissinotti
- Servicio de Medicina Nuclear, Hospital Clínic Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), ISCIII, Madrid, Spain
| | - Catalina Sampol
- Servicio de Medicina Nuclear, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Oscar Vidal
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Cirugía General y Digestiva, ICMDiM, Hospital Clínic de Barcelona, Barcelona, Spain; Departamento de Cirugía, Universitat de Barcelona, Barcelona, Spain
| | - David Saavedra-Pérez
- Cirugía General y Digestiva, ICMDiM, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ada Ferrer
- Servicio de Cirugía Maxilofacial, Hospital Clínic Barcelona, Barcelona, Spain
| | - Carles Martí
- Servicio de Cirugía Maxilofacial, Hospital Clínic Barcelona, Barcelona, Spain
| | - José Ferrer Rebolleda
- Servicio Medicina Nuclear Ascires, Hospital General Universitario de Valencia, Valencia, Spain
| | | | - Jhon Orozco-Cortés
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valencia, Barcelona, Spain
| | - Berta Díaz-Feijóo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Instituto Clínic de Ginecología, Obstetricia y Neonatología (ICGON), Hospital Clínic Barcelona, Barcelona, Spain; Departamento de Cirugía, Universitat de Barcelona, Barcelona, Spain
| | - Aida Niñerola-Baizán
- Servicio de Medicina Nuclear, Hospital Clínic Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), ISCIII, Madrid, Spain; Departamento de Biomedicina, Facultad de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Renato Alfredo Valdés Olmos
- Department of Radiology, Section of Nuclear Medicine & Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands
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18
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Fang AM, Jackson J, Gregg JR, Chery L, Tang C, Surasi DS, Siddiqui BA, Rais-Bahrami S, Bathala T, Chapin BF. Surgical Management and Considerations for Patients with Localized High-Risk Prostate Cancer. Curr Treat Options Oncol 2024; 25:66-83. [PMID: 38212510 DOI: 10.1007/s11864-023-01162-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/13/2024]
Abstract
OPINION STATEMENT Localized high-risk (HR) prostate cancer (PCa) is a heterogenous disease state with a wide range of presentations and outcomes. Historically, non-surgical management with radiotherapy and androgen deprivation therapy was the treatment option of choice. However, surgical resection with radical prostatectomy (RP) and pelvic lymph node dissection (PLND) is increasingly utilized as a primary treatment modality for patients with HRPCa. Recent studies have demonstrated that surgery is an equivalent treatment option in select patients with the potential to avoid the side effects from androgen deprivation therapy and radiotherapy combined. Advances in imaging techniques and biomarkers have also improved staging and patient selection for surgical resection. Advances in robotic surgical technology grant surgeons various techniques to perform RP, even in patients with HR disease, which can reduce the morbidity of the procedure without sacrificing oncologic outcomes. Clinical trials are not only being performed to assess the safety and oncologic outcomes of these surgical techniques, but to also evaluate the role of surgical resection as a part of a multimodal treatment plan. Further research is needed to determine the ideal role of surgery to potentially provide a more personalized and tailored treatment plan for patients with localized HR PCa.
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Affiliation(s)
- Andrew M Fang
- Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA
| | - Jamaal Jackson
- Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA
| | - Justin R Gregg
- Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA
| | - Lisly Chery
- Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA
| | - Chad Tang
- Department of Genitourinary Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Devaki Shilpa Surasi
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bilal A Siddiqui
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
- Department of Radiology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
- Neal Comprehensive Cancer Center, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Tharakeswara Bathala
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brian F Chapin
- Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA.
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19
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Esen T, Esen B, Yamaoh K, Selek U, Tilki D. De-Escalation of Therapy for Prostate Cancer. Am Soc Clin Oncol Educ Book 2024; 44:e430466. [PMID: 38206291 DOI: 10.1200/edbk_430466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Prostate cancer (PCa) is the second most commonly diagnosed cancer in men with around 1.4 million new cases every year. In patients with localized disease, management options include active surveillance (AS), radical prostatectomy (RP; with or without pelvic lymph node dissection), or radiotherapy to the prostate (with or without pelvic irradiation) with or without hormonotherapy. In advanced disease, treatment options include systemic treatment(s) and/or treatment to primary tumour and/or metastasis-directed therapies (MDTs). Specifically, in advanced stage, the current trend is earlier intensification of treatment such as dual or triple combination systemic treatments or adding treatment to primary and MDT to systemic treatment. However, earlier treatment intensification comes with the cost of increased morbidity and mortality resulting from drug-/treatment-related side effects. The main goal is and should be to provide the best possible care and oncologic outcomes with minimum possible side effects. This chapter will explore emerging possibilities to de-escalate treatment in PCa driven by enhanced insights into disease biology and the natural course of PCa such as AS in intermediate-risk disease or salvage versus adjuvant radiotherapy in post-RP patients. Considerations arising from advancements in PCa imaging and technological advancements in surgical and radiation therapy techniques including omitting pelvic lymph node dissection in the era of prostate-specific membrane antigen positron emitting tomography, the potential of MDT to delay/omit systemic treatment in metachronous oligorecurrence, and the efficacy of hypofractionation schemes compared with conventional fractionated radiotherapy will be discussed.
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Affiliation(s)
- Tarik Esen
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
| | - Baris Esen
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
| | - Kosj Yamaoh
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL
| | - Ugur Selek
- Department of Radiation Oncology, Koc University School of Medicine, Istanbul, Turkey
| | - Derya Tilki
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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20
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Zhang H, Xiao L, Xie H, Li L. Hotspots and frontiers in PSMA research for prostate cancer: a bibliometric and visualization analysis over the past 20 years. Eur J Med Res 2023; 28:610. [PMID: 38115121 PMCID: PMC10731714 DOI: 10.1186/s40001-023-01590-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Prostate-specific membrane antigen (PSMA)-targeted imaging and therapy have significantly changed the management of patients with prostate cancer (PCa) at different disease stages. This advancement has attracted the attention of scholars, leading to a prolific output of scholarly publications. This study comprehensively outlines the knowledge framework associated with PSMA-based diagnosis and treatment of PCa through the application of bibliometric analysis, and discusses the potential research trends and foci. METHODS Articles and reviews related to PSMA for prostate cancer from 2003 to 2022 were retrieved from Web of Science Core Collection. VOSviewer, Citespace, and R-bibliometrix were primarily employed to execute and visually represent co-authorship, co-citation, and co-occurrence analysis of countries, institutions, authors, references and keywords in this field. RESULTS A total of 3830 papers were included. The papers on the field of PSMA-based PCa therapy and imaging had been continuously increased since 2003, but the rate has slowed from 2020. The United States made the largest contribution in this field, in terms of publications 997 (26.03%), H-index (110) and total citations (53,167 times). We identified the most productive institution were Technical University of Munich, and Australian institutions had become very active in recent years. Journal of Nuclear Medicine was the most prominent journal in this field. Professors Matthias Eiber and Martin G Pomper made great achievements, while Ali Afshar-Oromieh was the most co-cited author. According to the result of keywords and topics analysis, "ga-68 labeled psma ligand", "radiation dosimetry" and "HBED-CC" were major research areas in the near future, while "Extended pelvic lymph node dissection" was considered to be the future research foci. CONCLUSIONS The field of psma-based PCa therapy and imaging is in the stage of vigorous development and has a bright prospect. The United States and Germany have achieved outstanding results in this area, while Australia has recently developed rapidly. It is foreseeable that more research foci will be lied in the early detection of pelvic lymph nodes and the multimodal imaging-guided surgery.
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Affiliation(s)
- Hanfei Zhang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Liu Xiao
- Department of Nuclear Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Hangyu Xie
- Department of Nuclear Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Lin Li
- Department of Nuclear Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China.
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21
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Gandaglia G, Barletta F, Robesti D, Scuderi S, Rajwa P, Gomez Rivas J, Ibanez L, Soeterik TFW, Bianchi L, Afferi L, Kesch C, Darr C, Guo H, Zhuang J, Zattoni F, Fendler W, Marra G, Stabile A, Amparore D, Huebner NA, Giesen A, Joniau S, Schiavina R, Brunocilla E, Mattei A, Dal Moro F, Sierra JM, Porpiglia F, Picchio M, van den Bergh R, Shariat SF, Montorsi F, Briganti A. Identification of the Optimal Candidates for Nodal Staging with Extended Pelvic Lymph Node Dissection Among Prostate Cancer Patients Who Underwent Preoperative Prostate-specific Membrane Antigen Positron Emission Tomography. External Validation of the Memorial Sloan Kettering Cancer Center and Briganti Nomograms and Development of a Novel Tool. Eur Urol Oncol 2023; 6:543-552. [PMID: 37270378 DOI: 10.1016/j.euo.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/15/2023] [Accepted: 05/06/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Although the therapeutic role of extended pelvic lymph node dissection (ePLND) in patients with prostate cancer (PCa) is still under debate, this procedure is recommended for staging purposes in selected cases. Nomograms for predicting lymph node invasion (LNI) do not account for prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging, which is characterized by a high negative predictive value for nodal metastases. OBJECTIVE To externally validate models predicting LNI in patients with miN0M0 PCa at PSMA PET and to develop a novel tool in this setting. DESIGN, SETTING, AND PARTICIPANTS Overall, 458 patients with miN0M0 disease undergoing radical prostatectomy (RP) and ePLND at 12 centers between 2017 and 2022 were identified. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES Available tools were externally validated using calibration plots, the area under the receiver operating characteristic curve (AUC), and decision curve analyses to assess calibration, discrimination, and the net benefit. A novel coefficient-based model was developed, internally validated, and compared with available tools. RESULTS AND LIMITATIONS Overall, 53 patients (12%) had LNI. The AUC was 69% for the Briganti 2012, 64% for the Briganti 2017, 73% for the Briganti 2019, and 66% for the Memorial Sloan Kettering Cancer Center nomogram. Multiparametric magnetic resonance imaging stage, biopsy grade group 5, the diameter of the index lesion, and the percentage of positive cores at systematic biopsy were independent predictors of LNI (all p ≤ 0.04). Internal cross-validation confirmed a coefficient-based model with AUC of 78%, better calibration, and a higher net benefit in comparison to the other nomograms assessed. Use of a 5% cutoff would have spared 47% ePLND procedures (vs 13% for the Briganti 2019 nomogram) at the cost of missing only 2.1% LNI cases . The lack of central review of imaging and pathology represents the main limitation. CONCLUSIONS Tools for predicting LNI are associated with suboptimal performance for men with miN0M0 PCa. We propose a novel model for predicting LNI that outperforms available tools in this population. PATIENT SUMMARY Tools currently used to predict lymph node invasion (LNI) in prostate cancer are not optimal for men with negative node findings on PET (positron emission tomography) scans, leading to a high number of unnecessary extended pelvic lymph node dissection (ePLND) procedures. A novel tool should be used in clinical practice to identify candidates for ePLND to reduce the risk of unnecessary procedures without missing LNI cases.
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Affiliation(s)
- Giorgio Gandaglia
- Unit of Urology, Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Francesco Barletta
- Unit of Urology, Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Daniele Robesti
- Unit of Urology, Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Simone Scuderi
- Unit of Urology, Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Pawel Rajwa
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Juan Gomez Rivas
- Department of Urology, Hospital Clinico San Carlos, Madrid, Spain
| | - Laura Ibanez
- Department of Urology, Hospital Clinico San Carlos, Madrid, Spain
| | - Timo F W Soeterik
- Department of Urology, St. Antonius Hospital, Utrecht, The Netherlands
| | - Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Claudia Kesch
- Department of Urology, West German Cancer Center, University of Duisburg, Essen, Germany; German Cancer Consortium, University Hospital Essen, Essen, Germany
| | - Christopher Darr
- Department of Urology, West German Cancer Center, University of Duisburg, Essen, Germany; German Cancer Consortium, University Hospital Essen, Essen, Germany
| | - Hongqian Guo
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Jiangsu, China
| | - Junlong Zhuang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Jiangsu, China
| | - Fabio Zattoni
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, Padua, Italy
| | - Wolfgang Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen, Essen, Germany
| | - Giancarlo Marra
- University Hospital S. Giovanni Battista, Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, Turin, Italy
| | - Armando Stabile
- Unit of Urology, Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniele Amparore
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, Turin, Italy
| | - Nicolai A Huebner
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Alexander Giesen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Eugenio Brunocilla
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Fabrizio Dal Moro
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, Padua, Italy
| | | | - Francesco Porpiglia
- University Hospital S. Giovanni Battista, Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, Turin, Italy
| | - Maria Picchio
- Vita-Salute San Raffaele University, Milan, Italy; Department of Nuclear Medicine, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | | | - Francesco Montorsi
- Unit of Urology, Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology, Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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22
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Strauß AS, Bolenz C, Beer AJ, Zengerling F, Beer M, Miksch J. [Opportunities for prostate-specific membrane antigen hybrid imaging in prostate cancer]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:1153-1159. [PMID: 37702749 DOI: 10.1007/s00120-023-02189-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/14/2023]
Abstract
Prostate-specific membrane antigen (PSMA) hybrid imaging is a promising new technique gaining importance in the field of prostate cancer (PCa) diagnosis and treatment planning. By combining PSMA radioligands and computed tomography (CT) or magnetic resonance imaging (MRI), PSMA hybrid imaging opens up new diagnostic opportunities. PSMA-PET/CT (PET: positron-emission tomography) is already well established in high-risk PCa for primary staging and tumor localization when biochemical recurrence occurs. Further potential indications for PSMA-PET/CT include tumor detection in the initial work-up before a rebiopsy with improved accuracy, the identification of target structures for precise local treatment in recurrent PCa (salvage radiotherapy or radio-guided surgery) as well as a prediction of response to PSMA radioligand therapy. This narrative review is based on a recent literature search and aims to highlight the opportunities of PSMA imaging in different disease stages of PCa.
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Affiliation(s)
- Anna-Sophie Strauß
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
| | - Christian Bolenz
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
- Innovative Imaging in Surgical Oncology Ulm, I2SOUL-Consortium, Ulm, Deutschland
| | - Ambros J Beer
- Klinik für Nuklearmedizin, Universitätsklinikum Ulm, Ulm, Deutschland
- Innovative Imaging in Surgical Oncology Ulm, I2SOUL-Consortium, Ulm, Deutschland
| | - Friedemann Zengerling
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
- Innovative Imaging in Surgical Oncology Ulm, I2SOUL-Consortium, Ulm, Deutschland
| | - Meinrad Beer
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Ulm, Deutschland
- Innovative Imaging in Surgical Oncology Ulm, I2SOUL-Consortium, Ulm, Deutschland
| | - Jonathan Miksch
- Klinik für Nuklearmedizin, Universitätsklinikum Ulm, Ulm, Deutschland
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23
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Barletta F, Ceci F, van den Bergh RCN, Rajwa P, Montorsi F, Briganti A, Gandaglia G. The role of nuclear medicine tracers for prostate cancer surgery: from preoperative to intraoperative setting. Curr Opin Urol 2023; 33:502-509. [PMID: 37530704 DOI: 10.1097/mou.0000000000001118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
PURPOSE OF REVIEW There has been a growing interest in the use of novel molecular imaging modalities for the management of prostate cancer (PCa), spanning from diagnostic to therapeutic settings. The aim of this review is to provide a comprehensive overview of recently published studies investigating the use of novel nuclear medicine tracers across different stages of PCa management. RECENT FINDINGS Emerging evidence supports the use of molecular imaging for preoperative staging of PCa, where prostate-specific membrane antigen (PSMA) PET has shown superior accuracy compared to conventional imaging for the detection of nodal and distant metastases, which needs to be translated to new risk stratification. A role for PSMA PET has been proposed for PCa diagnosis, with local activity associated with histology. Surgical guidance, using either visual feedback or gamma-ray detectors to identify tissues with accumulated radio-labeled tracers, may improve the ability to resect locoregional diseases and thus maximize oncological control. PSMA targeted therapy (Lu-PSMA) has been mainly investigated in the castration-resistant setting, but might have a role in earlier settings such as neoadjuvant treatment. SUMMARY Novel molecular imaging using PSMA-based tracers could significantly improve PCa management in the diagnosis, staging, and intraoperative guidance settings, potentially leading to personalized and effective treatment decisions.
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Affiliation(s)
- Francesco Barletta
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University
| | - Francesco Ceci
- Division of Nuclear Medicine, European Institute of Oncology IRCCS; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | | | - Pawel Rajwa
- Department of Urology, Medical University of Silesia, Zabrze, Poland
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University
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24
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Handke AE, Ritter M, Albers P, Noldus J, Radtke JP, Krausewitz P. [Prostate cancer-multiparametric MRI and alternative approaches in intervention and therapy planning]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:1160-1168. [PMID: 37666944 DOI: 10.1007/s00120-023-02190-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND In recent years, multiparametric magnetic resonance imaging (mpMRI) of the prostate has gained importance and plays a crucial role in both personalized diagnostics and increasingly in the treatment planning for patients with prostate cancer. OBJECTIVE The aim of this study is to present established and innovative applications of MRI in the diagnosis and treatment of localized prostate cancer, evaluating their strengths and weaknesses. Furthermore, it will explore alternative approaches and compare them in a comprehensive manner. MATERIALS AND METHODS A systematic literature review on the application of mpMRI for biopsy and therapy planning was conducted. RESULTS The integration of modern imaging techniques, especially mpMRI, into the diagnostic algorithm has revolutionized prostate cancer diagnosis. MRI and MRI-guided biopsy detect more significant prostate cancer, with the potential to reduce unnecessary biopsies and the diagnosis of clinically insignificant carcinomas. In addition, MRI provides crucial information for risk stratification and treatment planning in prostate cancer patients, both before radical prostatectomy and during active surveillance. CONCLUSION Multiparametric MRI offers significant added value for the diagnosis and treatment of localized prostate cancer. The advancement of MRI analysis, such as the implementation of artificial intelligence algorithms, holds the potential for further enhancing imaging diagnostics.
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Affiliation(s)
- Analena Elisa Handke
- Marienhospital Herne, Universitätsklinikum, Ruhr-Universität Bochum, Herne, Deutschland
| | - Manuel Ritter
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Peter Albers
- Klinik für Urologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
- Abteilung für Personalisierte Früherkennung des Prostatakarzinoms, Deutsches Krebsforschungszentrum (dkfz), Heidelberg, Deutschland
| | - Joachim Noldus
- Marienhospital Herne, Universitätsklinikum, Ruhr-Universität Bochum, Herne, Deutschland
| | - Jan Philipp Radtke
- Klinik für Urologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
- Abteilung für Personalisierte Früherkennung des Prostatakarzinoms, Deutsches Krebsforschungszentrum (dkfz), Heidelberg, Deutschland
- Abteilung Radiologie, Deutsches Krebsforschungszentrum (dkfz), Heidelberg, Deutschland
| | - Philipp Krausewitz
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
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Alemi M, Banouei F, Ahmadi R. Comparison of Diagnostic Value between 99mTechnetium-Methylene Diphosphate Bone Scan and 99mTechnetium-Prostate-specific Membrane Antigen Scan in Patients with Prostate Cancer with Osseous Metastases. Indian J Nucl Med 2023; 38:340-349. [PMID: 38390538 PMCID: PMC10880839 DOI: 10.4103/ijnm.ijnm_52_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/10/2023] [Accepted: 09/25/2023] [Indexed: 02/24/2024] Open
Abstract
Background Prostate cancer (PCa) ranks as the second most prevalent cancer among men globally. The utilization of efficient and cost-effective diagnostic and therapeutic approaches holds paramount importance in the diagnosis and treatment of these patients, significantly impacting treatment outcomes. This study focuses on the investigation and comparison of two commonly employed scans within the treatment process for these patients. Methods In this prospective study, which spanned over 2 years, 40 patients diagnosed with PCa underwent examination using two scans: 99m Technetium-Prostate-specific Membrane Antigen (99mTC-PSMA) Scan and between Technetium-Methylene Diphosphate (99mTC-MDP) Bone Scan. The findings of these scans were then compared with each other, as well as with the results obtained from magnetic resonance imaging and the prostate-specific antigen level. The analysis of the results was conducted utilizing SPSS 22 software, and descriptive statistical methods were employed to present the findings. Results In this prospective study, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the 99mTC-MDP Bone Scan were found to be 88.2%, 83.3%, 96.7%, 55.5%, and 87.5%, respectively. Similarly, for the 99mTC-PSMA Scan, the corresponding values were 94.1%, 83.3%, 96.4%, 83.3%, and 92.5%, respectively. Conclusions Based on the findings of this study, it can be concluded that the diagnostic accuracy of the 99mTC-PSMA Scan is marginally higher compared to the 99mTC-MDP Bone Scan. Therefore, for patients who are limited to only one scan, the 99mTC-PSMA Scan appears to be the preferable choice.
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Affiliation(s)
- Mohsen Alemi
- Urology and Nephrology Research Center, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Farshad Banouei
- Urology and Nephrology Research Center, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Reyhaneh Ahmadi
- Department of Nuclear Medicine, School of Medicine, Hamedan University of Medical Sciences, Hamedan, Iran
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Lucas Lucas C, García Zoghby L, Amo-Salas M, Soriano Castrejón ÁM, García Vicente AM. Diagnostic and therapeutic impact of PET/CT with 18F-DCFPyL versus 18F-Fluorocholine in initial staging of intermediate-/high-risk prostate cancer: a pilot study. Ann Nucl Med 2023; 37:551-560. [PMID: 37532975 DOI: 10.1007/s12149-023-01859-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/09/2023] [Indexed: 08/04/2023]
Abstract
AIM To assess the diagnostic and therapeutic impact of PET/CT with 18F-DCFPyL with respect to 18F-Fluorocholine in initial staging of intermediate-/high-risk prostate cancer (PCa). MATERIAL AND METHODS Patients with recent diagnosis of intermediate-/high-risk PCa without androgen deprivation therapy and previous 18F-Fluorocholine-PET/CT (negative for extraprostatic disease or with oligometastatic disease) were referred to 18F-DCFPyL-PET/CT. Patients' disease characteristic as grade group, D'Amico risk category (intermediate/high), prostate-specific antigen (PSA) closest to PET/CTs and its kinetics were obtained. The overall detection rate (DR) and molecular imaging TNM (miTNM) stage according to the prostate cancer molecular imaging standardized evaluation (PROMISE) criteria were assessed for both radiotracers, and their concordance (Kappa coefficient) was analyzed. The diagnostic and therapeutic impact of 18F-DCFPyL with respect to 18F-Fluorocholine was evaluated. RESULTS Fifty-eight patients were analyzed (84.5% high-risk). 18F-Fluorocholine showed a higher DR than 18F-DCFPyL of prostate gland involvement (100% versus 93.1%) and pelvic node disease (37.9% versus 31%; k = 0.436, p = 0.001). On the other hand, 18F-DCFPyL-PET/CT showed a higher DR of metastatic disease than 18F-Fluorocholine-PET/CT, 9/58 patients (15.5%): 3 M1a, 5 M1b and 1 M1c) versus 5/58 (8.6%) patients: 1 M1a and 4 M1b), k = 0.426; p = 0.001. No significant association was found between clinical characteristics (grade group, risk category, PSA level and kinetic) and 18F-Fluorocholine or 18F-DCFPyL results. The results of 18F-DCFPyL-PET/CT modified the previously planned treatment compared to 18F-Fluorocholine-PET/CT in 13 patients (22.4%). CONCLUSIONS 18F-Fluorocholine and 18F-DCFPyL PET/CT showed a similar DR of prostate gland and lymph node involvement, although with moderate concordance for the latter. 18F-DCFPyL was superior to 18F-Fluorocholine in detecting regional and distant metastasis with a therapeutic impact in one of every five patients.
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Affiliation(s)
- Cristina Lucas Lucas
- Nuclear Medicine Department, University General Hospital, C/Obispo Rafael Torija s/n, 13005, Ciudad Real, Spain
| | - Laura García Zoghby
- Nuclear Medicine Department, Complejo Hospitalario de Toledo, Avda. Rio Guadiana s/n, 45007, Toledo, Spain
| | - Mariano Amo-Salas
- Department of Mathematics, Castilla-La Mancha University, Ciudad Real, Spain
| | | | - Ana María García Vicente
- Nuclear Medicine Department, Complejo Hospitalario de Toledo, Avda. Rio Guadiana s/n, 45007, Toledo, Spain.
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Kiełb P, Kaczorowski M, Kowalczyk K, Piotrowska A, Nowak Ł, Krajewski W, Gurwin A, Dudek K, Dzięgiel P, Hałoń A, Szydełko T, Małkiewicz B. Comparative analysis of GOLPH3 expression in lymph node-positive prostate cancer: immunohistochemistry staining patterns and clinical significance. Front Oncol 2023; 13:1265788. [PMID: 37790749 PMCID: PMC10544905 DOI: 10.3389/fonc.2023.1265788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction Prostate cancer (PCa) is the second most commonly diagnosed cancer in men worldwide. Lymph node metastasis is a poor prognostic factor for PCa. Previous studies have found that Golgi phosphoprotein 3 (GOLPH3) is overexpressed in various cancers, including PCa. We examined GOLPH3 expression in PCa cells from primary tumor and, as the first, also in metastatic lymph nodes to assess its potential as a new risk factor for PCa progression. Methods The study included 78 patients diagnosed with lymph node-positive PCa confirmed in the postoperative material. All the patients underwent radical prostatectomy (RP) with extended lymphadenectomy. The clinical data of the patients were retrospectively analyzed, and their histopathological specimens were selected for further analysis. Immunohistochemistry (IHC) staining was performed and the expression of GOLPH3 was assessed by an experienced uropathologist using an immunoreactive scale (IRS). A correlational analysis of the obtained data with the clinicopathological data of patients was performed. Results A positive IHC reaction for GOLPH3 was observed in all samples. IRS score for GOLPH3 expression was higher in the metastatic lymph nodes than in the prostate (not statistically significant; p=0.056). Several significant correlations were identified in connection with GOLPH3 expression levels in the prostate and metastatic lymph node tissues. No significant correlations were found between GOLPH3 expression and patient characteristics (e.g. BMI, EAU risk group, or preoperative PSA level), pathological features, or postoperative outcomes. However, we found that lymphovascular invasion (LVI) tended to be more common in patients with a higher percentage of GOLPH3-positive cells (p=0.02). We also found a positive association between the intensity of GOLPH3 staining in metastatic lymph nodes and the EAU classification. Finally, we found a significant negative correlation between the GOLPH3 expression and the efficacy of RP - the higher the expression of GOLPH3, the lower the efficacy of RP was (p<0.05). Conclusion GOLPH3 is expressed in both prostate and metastatic lymph nodes, with higher expression in metastatic lymph nodes. High GOLPH3 expression was associated with the occurrence of LVI, higher-risk group in the EAU classification, and lower efficacy of the RP, but there was no significant correlation with other pathological features or postoperative outcomes.
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Affiliation(s)
- Paweł Kiełb
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Maciej Kaczorowski
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, Wroclaw, Poland
| | - Kamil Kowalczyk
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Aleksandra Piotrowska
- Division of Histology and Embryology, Department of Human Morphology and Embryology, Wroclaw Medical University, Wroclaw, Poland
| | - Łukasz Nowak
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Wojciech Krajewski
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Adam Gurwin
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Dudek
- Center for Statistical Analysis, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Dzięgiel
- Division of Histology and Embryology, Department of Human Morphology and Embryology, Wroclaw Medical University, Wroclaw, Poland
| | - Agnieszka Hałoń
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, Wroclaw, Poland
| | - Tomasz Szydełko
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Bartosz Małkiewicz
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, Wroclaw, Poland
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Kiełb P, Kaczorowski M, Kowalczyk K, Piotrowska A, Nowak Ł, Krajewski W, Chorbińska J, Dudek K, Dzięgiel P, Hałoń A, Szydełko T, Małkiewicz B. Role of IL-17A and IL-17RA in Prostate Cancer with Lymph Nodes Metastasis: Expression Patterns and Clinical Significance. Cancers (Basel) 2023; 15:4578. [PMID: 37760548 PMCID: PMC10526823 DOI: 10.3390/cancers15184578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/05/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Prostate cancer (PCa) is the second most frequently diagnosed cancer among men. The use of IL-17A and its receptor IL-17RA as prognostic markers for PCa has shown promising results. We analyzed the clinical data of 77 patients with PCa after radical prostatectomy with lymphadenectomy and lymph node metastasis (LN+). We assessed the expression levels of IL-17A and IL-17RA in cancer cells in prostate and, for the first time, also in LN+. Prostate IL-17A expression positively correlated with BMI (p = 0.028). In LN+, the expression of IL-17A was positively correlated with the percentage of affected lymph nodes (p = 0.006) and EAU risk groups (p = 0.001). Additionally, in the group with high IL-17A expression in LN+, the extracapsular extension (ECE) of the prostate was significantly more frequent (p = 0.033). Also, significant correlations with the level of IL-17RA expression was found-expression was higher in prostate than in LN+ (p = 0.009); in LN+, expression positively correlated with the EAU risk group (p = 0.045), and in the group of high expression in LN+ ECE of lymph nodes was detected significantly more often (p = 0.009). Our findings support the potential role of IL-17A and IL-17RA as PCa markers; however, further studies are needed to determine their roles and potential clinical applications.
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Affiliation(s)
- Paweł Kiełb
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (Ł.N.); (W.K.); (J.C.); (T.S.)
| | - Maciej Kaczorowski
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.K.); (A.H.)
| | - Kamil Kowalczyk
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (Ł.N.); (W.K.); (J.C.); (T.S.)
| | - Aleksandra Piotrowska
- Division of Histology and Embryology, Department of Human Morphology and Embryology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (A.P.); (P.D.)
| | - Łukasz Nowak
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (Ł.N.); (W.K.); (J.C.); (T.S.)
| | - Wojciech Krajewski
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (Ł.N.); (W.K.); (J.C.); (T.S.)
| | - Joanna Chorbińska
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (Ł.N.); (W.K.); (J.C.); (T.S.)
| | - Krzysztof Dudek
- Center for Statistical Analysis, Wroclaw Medical University, Marcinkowskiego 2-6, 50-368 Wroclaw, Poland;
| | - Piotr Dzięgiel
- Division of Histology and Embryology, Department of Human Morphology and Embryology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (A.P.); (P.D.)
| | - Agnieszka Hałoń
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.K.); (A.H.)
| | - Tomasz Szydełko
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (Ł.N.); (W.K.); (J.C.); (T.S.)
| | - Bartosz Małkiewicz
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (K.K.); (Ł.N.); (W.K.); (J.C.); (T.S.)
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Hoffman A, Amiel GE. The Impact of PSMA PET/CT on Modern Prostate Cancer Management and Decision Making-The Urological Perspective. Cancers (Basel) 2023; 15:3402. [PMID: 37444512 DOI: 10.3390/cancers15133402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/14/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Prostate-specific membrane antigen (PSMA) PET use in prostate cancer treatment has recently become a routinely used imaging modality by urologists. New, established data regarding its performance in different stages of prostate cancer, as well as gaining clinical knowledge with new tracers, drives the need for urologists and other clinicians to improve the utilization of this tool. While the use of PSMA PET/CT is more common in metastatic disease, in which it outperforms classical imaging modalities and drives treatment decisions and adjustments, recently, it gained ground in localized prostate cancer as well, especially in high-risk disease. Still, PSMA PET/CT might reveal lesions within the prostate or possibly locoregional or metastatic disease, not always representing true cancer when utilized in earlier stages of the disease, potentially adding diagnostic burden and changing treatment decisions. As urological treatment options advance toward focal treatments in localized organ-confined prostate cancer, recent reports suggest the utilization of PSMA PET/CT in treatment planning and follow-up and even when choosing active surveillance. This review aims to reveal the current perspective of urologists regarding its daily use.
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Affiliation(s)
- Azik Hoffman
- Department of Urology, Rambam Health Care Center, Haifa 3109601, Israel
| | - Gilad E Amiel
- Department of Urology, Rambam Health Care Center, Haifa 3109601, Israel
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30
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Wang T, Zhao L, Qiao W, Sun N, Zhao J, Xing Y. The efficacy of 99mTc-HYNIC-PSMA SPECT/CT in detecting primary lesions and metastasis in newly diagnosed prostate cancer. Front Oncol 2023; 13:1165694. [PMID: 37333816 PMCID: PMC10272716 DOI: 10.3389/fonc.2023.1165694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/19/2023] [Indexed: 06/20/2023] Open
Abstract
Purpose Compared with PET/CT or PET/MRI, SPECT/CT is cheaper and more readily accessible. This study was designed to investigate the efficacy of 99mTc-HYNIC-PSMA SPECT/CT in detecting primary tumors and metastases in patients with newly diagnosed prostate cancer (PCa). Methods A retrospective analysis of 31 patients with pathologically proven PCa was performed at Shanghai General Hospital from November 2020 to November 2021. Planar whole-body imaging was performed on all patients with a SPECT/CT scan of PSMA-positive regions 3-4 h after intravenous injection of 740 MBq 99mTc-HYNIC-PSMA. Positive PSMA uptake lesions were evaluated, and SUVmean and SUVmax were measured in each lesion. Associations between SPECT/CT parameters and clinicopathologic factors (tPSA and Gleason Score) were analyzed. The diagnostic capability of SPECT/CT parameters, tPSA, and GS in distant metastatic detection was evaluated by logistic regression. Results The SUVmean and SUVmax of the high-risk stratification subgroups (tPSA>20 ng/ml, GS ≥8, and tPSA >20 ng/ml and GS≥8) were higher than those of the low-moderate risk stratification subgroups, with sensitivities of 92% and 92%, respectively. Neither SPECT/CT parameters (SUVmean, SUVmax) nor clinicopathologic factors (tPSA, GS) had high sensitivity (80%, 90%, 80%, and 90%, respectively, P <0.05) in distant metastatic prediction. For both the guideline tPSA level (20 ng/ml) and the cut-off level (84.3 ng/ml), the difference in the distant metastasis detection rate between the low predicted tPSA group and the high predicted tPSA group was statistically significant (0% vs. 47.62%, P = 0.005; 9.09% vs. 88.89%, P = 0.000, respectively). Twenty patients with pathological 99mTc-PSMA avid only in the prostate beds underwent radical prostatectomy. Seven of them underwent lymph node dissection, a total of 35 lymph nodes were removed, and no lymph nodes were detected with metastasis, which was consistent with 99mTc-HYNIC-PSMA SPECT/CT. Conclusion 99mTc-HYNIC-PSMA SPECT/CT is effective in the risk stratification and distant metastasis detection of primary PCa patients. It is of great value in guiding treatment strategies.
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Affiliation(s)
| | | | | | | | | | - Yan Xing
- *Correspondence: Jinhua Zhao, ; Yan Xing,
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31
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Rosiello G, Scilipoti P, Larcher A, Fallara G, Colandrea G, Basile G, Re C, Tian Z, Karakiewicz PI, Mottrie A, Trevisani F, Marandino L, Raggi D, Necchi A, Bertini R, Salonia A, Briganti A, Montorsi F, Capitanio U. Neglected lymph nodal metastases in patients with renal cancer: when to extend the anatomical template of lymph node dissection during nephrectomy. World J Urol 2023:10.1007/s00345-023-04413-z. [PMID: 37148324 DOI: 10.1007/s00345-023-04413-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/09/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND The role of lymph node dissection (LND) in patients with renal cell carcinoma (RCC) is still controversial. However, detecting lymph node invasion (LNI) is key due to prognostic implications and to identify patients who might benefit from adjuvant therapies such as adjuvant pembrolizumab. MATERIALS AND METHODS Out of 796 patients, 261 (33%) received eLND, of whom 62 (8%) for suspicious lymph node (LN) metastases at preoperative staging (cN1). eLND was divided in 3 anatomical areas: (1) hilar, (2) side-specific (pre-/para-aortic or pre-/para-caval) and (3) inter-aorto-caval nodes. Overall maximum LN diameter was measured by a dedicated radiologist for each patient. Multivariable logistic regression models (MVA) were tested for the effect of maximum LN diameter in predicting the presence of nodal metastases outside the anatomical area of cN1. RESULTS LNI was confirmed in 50% of cN1, whilst only 13 out of 199 cN0 patients were pN1 at final histology (6.5%; p < 0.001). In a per-patient analysis, of 62 cN1 patients, 24% vs. 18% vs. 8% harboured pN1 disease only inside vs. in-outside vs. only outside the suspicious anatomical field of cN1 at preoperative CT/MRI scan. At MVA, increasing diameter of suspicious LNs was independently associated with risk of finding positive LNs outside the suspicious anatomical field (OR 1.05, 95%CI 1.02-1.11; p = 0.02). CONCLUSIONS Roughly 50% of cN1 patients undergoing eLND will harbour LN metastases, also outside the suspicious radiological area, and maximum LNs diameter at preoperative imaging correlates with such risk. Thus, an eLND might be justified in patients with large suspicious LN metastases, to better stage this patient population and to improve postoperative treatment management.
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Affiliation(s)
- Giuseppe Rosiello
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
| | - Pietro Scilipoti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Alessandro Larcher
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Giuseppe Fallara
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Gianmarco Colandrea
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Giuseppe Basile
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Chiara Re
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | - Francesco Trevisani
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Laura Marandino
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Daniele Raggi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Andrea Necchi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Roberto Bertini
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Andrea Salonia
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Umberto Capitanio
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
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Schilham MGM, Rijpkema M, Scheenen T, Hermsen R, Barentsz JO, Sedelaar JPM, Kusters-Vandevelde H, Kerkmeijer LGW, Somford DM, Gotthardt M. Reply to Francesco Montorsi, Simone Scuderi, Alberto Briganti, and Giorgio Gandaglia's Letter to the Editor re: Melline G.M. Schilham, Mark Rijpkema, Tom Scheenen, et al. How Advanced Imaging Will Guide Therapeutic Strategies for Patients with Newly Diagnosed Prostate Cancer in the Years to Come. Eur Urol 2022;82:578-80. Eur Urol 2023; 83:e133-e134. [PMID: 36781337 DOI: 10.1016/j.eururo.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 02/13/2023]
Affiliation(s)
- Melline G M Schilham
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands; Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands; Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Mark Rijpkema
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tom Scheenen
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rick Hermsen
- Department of Nuclear Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Jelle O Barentsz
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J P Michiel Sedelaar
- Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands; Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Linda G W Kerkmeijer
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Diederik M Somford
- Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands; Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
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Montorsi F, Scuderi S, Briganti A, Gandaglia G. Re: Melline G.M. Schilham, Mark Rijpkema, Tom Scheenen, et al. How Advanced Imaging Will Guide Therapeutic Strategies for Patients with Newly Diagnosed Prostate Cancer in the Years to Come. Eur Urol 2022;82:578-80. Eur Urol 2023; 83:e132. [PMID: 36774224 DOI: 10.1016/j.eururo.2022.12.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/20/2022] [Indexed: 02/11/2023]
Affiliation(s)
- Francesco Montorsi
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Simone Scuderi
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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[Radiologic evaluation of lymph nodes in cancer patients]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:105-113. [PMID: 36633653 DOI: 10.1007/s00104-022-01802-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND In solid tumors, the detection of locoregional lymph node metastases is of decisive importance not only for the prognosis but also for selecting the correct treatment. Various noninvasive imaging methods or, classically, lymph node dissection are available for this purpose. OBJECTIVE This article presents the general principles of noninvasive lymph node diagnostics and discusses the value of the clinically available imaging modalities, ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET). In addition, recent new technical developments of each modality are highlighted. MATERIAL AND METHODS Literature search and summary of the clinical and scientific experience of the authors. RESULTS The available imaging procedures are divided into (1) morphological (US, CT, MRI) and (2) functional modalities (PET, special MRI). The former capture structural lymph node parameters, such as size and shape, while the latter address properties that go beyond morphology (e.g. glucose metabolism). The high diagnostic accuracy required for future treatment algorithms will require a combination of both aspects. DISCUSSION/CONCLUSION Currently, none of the available modalities have sufficient accuracy to replace lymph node dissection in all oncological scenarios. One of the major challenges for interdisciplinary oncological research is to define the optimal interaction between imaging and lymph node dissection for different malignancies and tumor stages.
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Hayes M, Yu Y, Bassale S, Chakiryan N, Chen Y, Ye S, Garzotto M, Kopp R. Calibrated Regression Models Based on the Risk of Clinical Nodal Metastasis Should be Used as Decision Aids for Prostate Cancer Staging to Reduce Unnecessary Imaging. Clin Genitourin Cancer 2022; 20:e490-e497. [PMID: 35649886 DOI: 10.1016/j.clgc.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Radionuclide imaging will change the role of computed tomography and magnetic resonance imaging (CT/MRI) for prostate cancer (CaP) staging. Current guidelines recommend abdominopelvic imaging for new cases of CaP categorized as unfavorable intermediate risk (UIR) or higher. We assessed the performance characteristics of CT/MRI based on the National Comprehensive Cancer Network (NCCN) guidelines and developed a model that predicts cN1 disease using conventional imaging. PATIENTS AND METHODS We selected patients in the National Cancer Database diagnosed with CaP from 2010 to 2016 with available age, prostate specific antigen, clinical locoregional staging, biopsy Gleason grading, and core information. Multivariate logistic regression (MLR) was used on a undersampled training dataset using cN1 as the outcome. Performance characteristics were compared to those of the three most recent versions of the NCCN guidelines. RESULTS A total of 443,640 men were included, and 2.5% had cN1 disease. Using CT/MRI only, the current NCCN guidelines have a sensitivity of 99%, and the number needed to image (NNI) is 24. At the same sensitivity, the cN1 risk was 1.6% using the MLR. The NNI for UIR alone is 341. Using the MLR model and a threshold of 10%, the PPV is 10.3% and 64% of CTs/MRIs could be saved at a cost of missing 6% of cN1 patients (or 0.15% of all patients). CONCLUSION The NCCN guidelines are sensitive for detecting cN1 with CT/MRI, however, the number needed to image is 24. Obtaining CT/MRI for nodal staging when patients have a cN1 risk of 10% would reduce total imaging while still remaining sensitive. As novel PET tracers becomes increasingly used for initial CaP staging, well calibrated prediction models trained on the outcome of interest should be developed as decision aids for obtaining imaging.
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Affiliation(s)
- Mitchell Hayes
- Department of Urology, Oregon Health and Science University, Portland, OR, USA.
| | - Yun Yu
- Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Solange Bassale
- Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | | | - Yiyi Chen
- Biometrics, Seagen, Inc., Bothell, WA, USA
| | - Shangyuan Ye
- Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Mark Garzotto
- Department of Urology, Oregon Health and Science University, Portland, OR, USA; Urology Section, VA Portland Healthcare System, Portland, OR, USA
| | - Ryan Kopp
- Department of Urology, Oregon Health and Science University, Portland, OR, USA; Urology Section, VA Portland Healthcare System, Portland, OR, USA
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36
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Wang Y, Tang Y, Gao X, Gan Y, Hu S, Chen MF, Cai Y. Optimization of prostate cancer patient lymph node staging via the integration of neutrophil-lymphocyte ratios, platelet-lymphocyte ratios, and 68 Ga-PSMA-PET-derived SUVmax values. Prostate 2022; 82:1415-1421. [PMID: 35860907 DOI: 10.1002/pros.24415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/12/2022] [Accepted: 07/04/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND At present, standardized parameters for quantitatively evaluating 68 Ga-PSMA-PET/CT outcomes when diagnosing lymph node metastasis in prostate cancer patients are lacking. Inflammatory hematological biomarkers offer value as robust predictors of certain cancer-related outcomes. The present study was thus developed to explore approaches to improving the utility of 68 Ga-PSMA-PET/CT for diagnosing lymph node metastasis through the combined evaluation of inflammatory hematological markers in prostate cancer patients. METHODS Pretreatment patient details including age, initial TPSA levels, hematological findings, biopsy pathology results (Gleason score and ISUP grouping), radical pathology results, and imaging details were collected. Optimal cutoff values for each predictor then being determined based upon Youden's index, with univariate and multivariate analyses were then used to identify independent predictors of lymph node metastasis and used to construct a nomogram. RESULT Independent predictors of lymph node metastasis in this patient cohort included SUVmax (odds ratio [OR]: 30.549, 95% confidence interval [CI]: 10.855-85.973, p < 0.001), neutrophil-lymphocyte ratio (OR:8.221, 95%CI: 1.335-50.614, p = 0.023), platelet-lymphocyte ratio (OR:8.221, 95% CI: 1.335-50.614, p = 0.023), initial TPSA (OR:2.761, 95% CI: 1.132-6.733, p = 0.026), and clinical T-stage (T3 vs. T2, OR:11.332, 95% CI:3.929-32.681, p < 0.001; T4 vs. T2, OR:9.101, 95% CI:1.962-42.213, p = 0.005), with corresponding optimal cutoff values of 2.3 (area under the curve [AUC]: 0.873, sensitivity: 0.736, specificity: 0.902), 1.72 (AUC: 0.558, sensitivity: 0.529, specificity: 0.643), 83.305 (AUC: 0.651, sensitivity: 0.299, specificity: 0.979), and 21.875 (AUC: 0.672, sensitivity: 0.736, specificity: 0.601). Subsequent nomogram construction was associated with good predictive ability, with a C-index of 0.887(95% CI: 0.793-0.981) and an AUC of 0.924 (95% CI: 0.882-0.965). CONCLUSION SUVmax, the neutrophil-lymphocyte ratio, the platelet-lymphocyte ratio, initial TPSA, and clinical T-stage represent valuable independent predictors of lymph node metastasis in prostate cancer patients, offering an opportunity to further optimize lymph node staging for these patients.
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Affiliation(s)
| | - Yongxiang Tang
- Department of Nuclear Medicine, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China
| | - Xiaomei Gao
- Department of Pathology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China
| | - Yu Gan
- Department of Urology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China
| | - Shuo Hu
- Department of Nuclear Medicine, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China
| | - Min-Feng Chen
- Department of Urology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China
| | - Yi Cai
- Department of Urology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China
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Combes AD, Palma CA, Calopedos R, Wen L, Woo H, Fulham M, Leslie S. PSMA PET-CT in the Diagnosis and Staging of Prostate Cancer. Diagnostics (Basel) 2022; 12:2594. [PMID: 36359439 PMCID: PMC9689635 DOI: 10.3390/diagnostics12112594] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/13/2022] [Accepted: 10/24/2022] [Indexed: 08/07/2023] Open
Abstract
Prostate cancer is the most common cancer and the second leading cause of cancer death in men. The imaging assessment and treatment of prostate cancer has vastly improved over the past decade. The introduction of PSMA PET-CT has improved the detection of loco-regional and metastatic disease. PSMA PET-CT also has a role in the primary diagnosis and staging, in detecting biochemical recurrence after curative treatment and in metastasis-directed therapy. In this paper we review the role of PSMA PET-CT in prostate cancer.
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Affiliation(s)
- Alexander D. Combes
- Department of Urology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Catalina A. Palma
- Department of Urology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Ross Calopedos
- Department of Urology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Lingfeng Wen
- Department of Molecular Imaging, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
- Faculty of Engineering and Computer Science, University of Sydney, Sydney, NSW 2006, Australia
| | - Henry Woo
- Faculty of Medicine, University of Sydney, Sydney, NSW 2006, Australia
- Department of Urology, Chris O’Brien Lifehouse, Sydney, NSW 2050, Australia
| | - Michael Fulham
- Department of Molecular Imaging, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
- Faculty of Medicine, University of Sydney, Sydney, NSW 2006, Australia
| | - Scott Leslie
- Department of Urology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
- Faculty of Medicine, University of Sydney, Sydney, NSW 2006, Australia
- Department of Urology, Chris O’Brien Lifehouse, Sydney, NSW 2050, Australia
- RPA Institute of Academic Surgery, Sydney, NSW 2050, Australia
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Pelvic Lymph Node Dissection at the Time of Radical Prostatectomy: Extended, of Course. EUR UROL SUPPL 2022; 44:13-14. [PMID: 36043188 PMCID: PMC9420501 DOI: 10.1016/j.euros.2022.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 11/21/2022] Open
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Schilham MGM, Rijpkema M, Scheenen T, Hermsen R, Barentsz JO, Michiel Sedelaar JP, Kusters-Vandevelde H, Kerkmeijer LGW, Somford DM, Gotthardt M. How Advanced Imaging Will Guide Therapeutic Strategies for Patients with Newly Diagnosed Prostate Cancer in the Years to Come. Eur Urol 2022; 82:578-580. [PMID: 36167598 DOI: 10.1016/j.eururo.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022]
Abstract
In recent years, clinical use of novel advanced imaging modalities in prostate cancer detection, staging, and therapy has intensified and is currently reforming clinical guidelines. In the future, advanced imaging technologies will continue to develop and become even more accurate, which will offer new opportunities for improving patient selection, surgical treatment, and radiotherapy, with the potential to guide prostate cancer therapy.
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Affiliation(s)
- Melline G M Schilham
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands; Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands; Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Mark Rijpkema
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tom Scheenen
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rick Hermsen
- Department of Nuclear Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Jelle O Barentsz
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J P Michiel Sedelaar
- Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands; Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Linda G W Kerkmeijer
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Diederik M Somford
- Prosper Prostate Cancer Clinics, Nijmegen/Eindhoven, The Netherlands; Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
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The Role of PSMA PET/CT in the Primary Diagnosis and Follow-Up of Prostate Cancer-A Practical Clinical Review. Cancers (Basel) 2022; 14:cancers14153638. [PMID: 35892897 PMCID: PMC9367536 DOI: 10.3390/cancers14153638] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary The combination of positron emission tomography (PET)-diagnostics with ligands binding to the prostate-specific membrane antigen (PSMA) has been a diagnostic milestone in the situation of biochemical recurrence of prostate cancer and is gaining importance in primary diagnostics, providing a highly specific and sensitive diagnostic method in various clinical situations. However, the clinical application of this method requires a comprehensive knowledge of its advantages and disadvantages, potential pitfalls and influencing factors. This review aims to provide a practical clinical review of the currently available background data on PSMA PET/CT, as well as the clinical implications. Although a large amount of data already exist, a thorough analysis is complicated by study heterogeneity, showing the need for future systematic and prospective research. Abstract The importance of PSMA PET/CT in both primary diagnostics and prostate cancer recurrence has grown steadily since its introduction more than a decade ago. Over the past years, a vast amount of data have been published on the diagnostic accuracy and the impact of PSMA PET/CT on patient management. Nevertheless, a large heterogeneity between studies has made reaching a consensus difficult; this review aims to provide a comprehensive clinical review of the available scientific literature, covering the currently known data on physiological and pathological PSMA expression, influencing factors, the differences and pitfalls of various tracers, as well as the clinical implications in initial TNM-staging and in the situation of biochemical recurrence. This review has the objective of providing a practical clinical overview of the advantages and disadvantages of the examination in various clinical situations and the body of knowledge available, as well as open questions still requiring further research.
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Gandaglia G, Mazzone E, Stabile A, Pellegrino A, Cucchiara V, Barletta F, Scuderi S, Robesti D, Leni R, Samanes Gajate AM, Picchio M, Gianolli L, Brembilla G, De Cobelli F, van Oosterom MN, van Leeuwen FWB, Montorsi F, Briganti A. Prostate-specific membrane antigen Radioguided Surgery to Detect Nodal Metastases in Primary Prostate Cancer Patients Undergoing Robot-assisted Radical Prostatectomy and Extended Pelvic Lymph Node Dissection: Results of a Planned Interim Analysis of a Prospective Phase 2 Study. Eur Urol 2022; 82:411-418. [PMID: 35879127 DOI: 10.1016/j.eururo.2022.06.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/30/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Extended pelvic nodal dissection (ePLND) represents the gold standard for nodal staging in prostate cancer (PCa). Prostate-specific membrane antigen (PSMA) radioguided surgery (RGS) could identify lymph node invasion (LNI) during robot-assisted radical prostatectomy (RARP). OBJECTIVE To report the planned interim analyses of a phase 2 prospective study (NCT04832958) aimed at describing PSMA-RGS during RARP. DESIGN, SETTING, AND PARTICIPANTS A phase 2 trial aimed at enrolling 100 patients with intermediate- or high-risk cN0cM0 PCa at conventional imaging with a risk of LNI of >5% was conducted. Overall, 18 patients were enrolled between June 2021 and March 2022. Among them, 12 patients underwent PSMA-RGS and represented the study cohort. SURGICAL PROCEDURE All patients received 68Ga-PSMA positron emission tomography (PET)/magnetic resonance imaging; 99mTc-PSMA-I&S was synthesised and administered intravenously the day before surgery, followed by single-photon emission computed tomography/computed tomography. A Drop-In gamma probe was used for in vivo measurements. All positive lesions (count rate ≥2 compared with background) were excised and ePLND was performed. MEASUREMENTS Side effects, perioperative outcomes, and performance characteristics of robot-assisted PSMA-RGS for LNI were measured. RESULTS AND LIMITATIONS Overall, four (33%), six (50%), and two (17%) patients had intermediate-risk, high-risk, and locally advanced PCa. Overall, two (17%) patients had pathologic nodal uptake at PSMA PET. The median operative time, blood loss, and length of stay were 230 min, 100 ml, and 5 d, respectively. No adverse events and intraoperative complications were recorded. One patient experienced a 30-d complication (Clavien-Dindo 2; 8.3%). Overall, three (25%) patients had LNI at ePLND. At per-region analyses on 96 nodal areas, sensitivity, specificity, positive predictive value, and negative predictive value of PSMA-RGS were 63%, 99%, 83%, and 96%, respectively. On a per-patient level, sensitivity, specificity, positive predictive value, and negative predictive values of PSMA-RGS were 67%, 100%, 100%, and 90%, respectively. CONCLUSIONS Robot-assisted PSMA-RGS in primary staging is a safe and feasible procedure characterised by acceptable specificity but suboptimal sensitivity, missing micrometastatic nodal disease. PATIENT SUMMARY Prostate-specific membrane antigen radioguided robot-assisted surgery is a safe and feasible procedure for the intraoperative identification of nodal metastases in cN0cM0 prostate cancer patients undergoing robot-assisted radical prostatectomy with extended pelvic lymph node dissection. However, this approach might still miss micrometastatic nodal dissemination.
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Affiliation(s)
- Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Elio Mazzone
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Armando Stabile
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Antony Pellegrino
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Vito Cucchiara
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Barletta
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Simone Scuderi
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Daniele Robesti
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Riccardo Leni
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | | | - Maria Picchio
- Vita-Salute San Raffaele University, Milan, Italy; Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Gianolli
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Brembilla
- Vita-Salute San Raffaele University, Milan, Italy; Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Vita-Salute San Raffaele University, Milan, Italy; Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matthias N van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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Małkiewicz B, Knura M, Łątkowska M, Kobylański M, Nagi K, Janczak D, Chorbińska J, Krajewski W, Karwacki J, Szydełko T. Patients with Positive Lymph Nodes after Radical Prostatectomy and Pelvic Lymphadenectomy—Do We Know the Proper Way of Management? Cancers (Basel) 2022; 14:cancers14092326. [PMID: 35565455 PMCID: PMC9104304 DOI: 10.3390/cancers14092326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Prostate cancer (PCa) is the second most frequent malignancy in the male population worldwide. Men with a nodal invasion established after radical prostatectomy with lymph node dissection are a heterogeneous group of patients who require more thorough stratification and therapy individualization, which remain uncovered by current guidelines. Considering a multitude of prognostic factors and novel diagnostic techniques, classifying patients into narrower and more specified risk groups should be a vital part of lymph node positive PCa management in the future. Abstract Lymph node invasion in prostate cancer is a significant prognostic factor indicating worse prognosis. While it significantly affects both survival rates and recurrence, proper management remains a controversial and unsolved issue. The thorough evaluation of risk factors associated with nodal involvement, such as lymph node density or extracapsular extension, is crucial to establish the potential expansion of the disease and to substratify patients clinically. There are multiple strategies that may be employed for patients with positive lymph nodes. Nowadays, therapeutic methods are generally based on observation, radiotherapy, and androgen deprivation therapy. However, the current guidelines are incoherent in terms of the most effective management approach. Future management strategies are expected to make use of novel diagnostic tools and therapies, such as photodynamic therapy or diagnostic imaging with prostate-specific membrane antigen. Nevertheless, this heterogeneous group of men remains a great therapeutic concern, and both the clarification of the guidelines and the optimal substratification of patients are required.
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Affiliation(s)
- Bartosz Małkiewicz
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-566 Wroclaw, Poland; (M.Ł.); (M.K.); (K.N.); (D.J.); (J.C.); (W.K.); (T.S.)
- Correspondence: (B.M.); (J.K.); Tel.: +48-506-158-136 (B.M.)
| | - Miłosz Knura
- Department of Biochemistry, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Małgorzata Łątkowska
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-566 Wroclaw, Poland; (M.Ł.); (M.K.); (K.N.); (D.J.); (J.C.); (W.K.); (T.S.)
| | - Maximilian Kobylański
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-566 Wroclaw, Poland; (M.Ł.); (M.K.); (K.N.); (D.J.); (J.C.); (W.K.); (T.S.)
| | - Krystian Nagi
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-566 Wroclaw, Poland; (M.Ł.); (M.K.); (K.N.); (D.J.); (J.C.); (W.K.); (T.S.)
| | - Dawid Janczak
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-566 Wroclaw, Poland; (M.Ł.); (M.K.); (K.N.); (D.J.); (J.C.); (W.K.); (T.S.)
| | - Joanna Chorbińska
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-566 Wroclaw, Poland; (M.Ł.); (M.K.); (K.N.); (D.J.); (J.C.); (W.K.); (T.S.)
| | - Wojciech Krajewski
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-566 Wroclaw, Poland; (M.Ł.); (M.K.); (K.N.); (D.J.); (J.C.); (W.K.); (T.S.)
| | - Jakub Karwacki
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-566 Wroclaw, Poland; (M.Ł.); (M.K.); (K.N.); (D.J.); (J.C.); (W.K.); (T.S.)
- Correspondence: (B.M.); (J.K.); Tel.: +48-506-158-136 (B.M.)
| | - Tomasz Szydełko
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-566 Wroclaw, Poland; (M.Ł.); (M.K.); (K.N.); (D.J.); (J.C.); (W.K.); (T.S.)
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Chen K, O'Brien J, McVey A, Kasivisvanathan V, Murphy DG. Re: Armando Stabile, Antony Pellegrino, Elio Mazzone, et al. Can Negative Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Avoid the Need for Pelvic Lymph Node Dissection in Newly Diagnosed Prostate Cancer Patients? A Systematic Review and Meta-analysis with Backup Histology as Reference Standard. Eur Urol Oncol 2022;5:1-17. Eur Urol Oncol 2022; 5:375-376. [PMID: 35331682 DOI: 10.1016/j.euo.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Kenneth Chen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Urology, Singapore General Hospital, Singapore
| | - Jonathan O'Brien
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Aoife McVey
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia.
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