TY - JOUR
T1 - Underestimation of positron emission tomography/computerized tomography in assessing tumor burden in prostate cancer nodal recurrence
T2 - Head-to-head comparison of 68Ga-PSMA and 11C-choline in a large, multi-institutional series of extended salvage lymph node dissections
AU - Fossati, Nicola
AU - Scarcella, Simone
AU - Gandaglia, Giorgio
AU - Suardi, Nazareno
AU - Robesti, Daniele
AU - Boeri, Luca
AU - Karnes, R. Jeffrey
AU - Heidenreich, Axel
AU - Pfister, David
AU - Kretschmer, Alexander
AU - Buchner, Alexander
AU - Stief, Christian
AU - Battaglia, Antonino
AU - Joniau, Steven
AU - Van Poppel, Hendrik
AU - Osmonov, Daniar
AU - Juenemann, Klaus Peter
AU - Shariat, Shahrokh
AU - Hiester, Andreas
AU - Nini, Alessandro
AU - Albers, Peter
AU - Tilki, Derya
AU - Graefen, Markus
AU - Gill, Inderbir S.
AU - Mottrie, Alexander
AU - Galosi, Andrea Benedetto
AU - Montorsi, Francesco
AU - Briganti, Alberto
N1 - Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Purpose:We compared the use of 11C-choline and 68Ga-prostate specific membrane antigen in men undergoing salvage lymph node dissection for nodal recurrent prostate cancer.Materials and Methods:The study included 641 patients who experienced prostate specific antigen rise and nodal recurrence after radical prostatectomy and underwent salvage lymph node dissection. Lymph node recurrence was documented by positron emission tomography/computerized tomography using 11C-choline (407, 63%) or 68Ga-PSMA ligand (234, 37%). The outcome was underestimation of tumor burden (difference between number of positive nodes on final pathology and number of positive spots at positron emission tomography/computerized tomography). Multivariable analysis tested the association between positron emission tomography/computerized tomography tracer (11C-choline vs 68Ga-PSMA) and tumor burden underestimation.Results:Overall the extent of tumor burden underestimation was significantly higher in the 11C-choline group compared to the 68Ga-PSMA group (p <0.0001), which was confirmed on multivariable analysis (p=0.028). Repeating these analyses according to prostate specific antigen, tumor burden underestimation was lower with 68Ga-PSMA only when prostate specific antigen was 1.5 ng/ml or less. Conversely, the underestimation of the 2 tracers became similar when prostate specific antigen was greater than 1.5 ng/ml. Furthermore, we evaluated the risk of underestimation by number of positive spots on positron emission tomography/computerized tomography. The higher the number of positive spots the higher the underestimation of tumor burden regardless of the tracer used (p=0.2).Conclusions:Positron emission tomography/computerized tomography significantly underestimates the burden of prostate cancer recurrence, regardless of the tracer used. 68Ga-PSMA was associated with a lower rate of underestimation in patients with a prostate specific antigen below 1.5 ng/ml and a limited nodal tumor load. In all other men there was no benefit from 68Ga-PSMA over 11C-choline in assessing the extent of nodal recurrence.
AB - Purpose:We compared the use of 11C-choline and 68Ga-prostate specific membrane antigen in men undergoing salvage lymph node dissection for nodal recurrent prostate cancer.Materials and Methods:The study included 641 patients who experienced prostate specific antigen rise and nodal recurrence after radical prostatectomy and underwent salvage lymph node dissection. Lymph node recurrence was documented by positron emission tomography/computerized tomography using 11C-choline (407, 63%) or 68Ga-PSMA ligand (234, 37%). The outcome was underestimation of tumor burden (difference between number of positive nodes on final pathology and number of positive spots at positron emission tomography/computerized tomography). Multivariable analysis tested the association between positron emission tomography/computerized tomography tracer (11C-choline vs 68Ga-PSMA) and tumor burden underestimation.Results:Overall the extent of tumor burden underestimation was significantly higher in the 11C-choline group compared to the 68Ga-PSMA group (p <0.0001), which was confirmed on multivariable analysis (p=0.028). Repeating these analyses according to prostate specific antigen, tumor burden underestimation was lower with 68Ga-PSMA only when prostate specific antigen was 1.5 ng/ml or less. Conversely, the underestimation of the 2 tracers became similar when prostate specific antigen was greater than 1.5 ng/ml. Furthermore, we evaluated the risk of underestimation by number of positive spots on positron emission tomography/computerized tomography. The higher the number of positive spots the higher the underestimation of tumor burden regardless of the tracer used (p=0.2).Conclusions:Positron emission tomography/computerized tomography significantly underestimates the burden of prostate cancer recurrence, regardless of the tracer used. 68Ga-PSMA was associated with a lower rate of underestimation in patients with a prostate specific antigen below 1.5 ng/ml and a limited nodal tumor load. In all other men there was no benefit from 68Ga-PSMA over 11C-choline in assessing the extent of nodal recurrence.
KW - lymph node excision
KW - positron-emission tomography computed tomography
KW - prostatic neoplasms
KW - recurrence
KW - salvage therapy
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U2 - 10.1097/JU.0000000000000800
DO - 10.1097/JU.0000000000000800
M3 - Article
C2 - 32068488
AN - SCOPUS:85087342847
SN - 0022-5347
VL - 204
SP - 296
EP - 301
JO - Investigative Urology
JF - Investigative Urology
IS - 2
ER -