A PROSPECTIVE EVALUATION OF PELVIC LYMPH NODE STAGING WITH (FLUORINE)-F-18 PROSTATE-SPECIFIC MEMBRANE ANTIGEN PET/CT PRIOR TO EXTENDED LYMPH NODE DISSECTION IN PRIMARY PROSTATE CANCER. THE SALT STUDY

You have accessJournal of UrologyProstate Cancer: Staging I (MP62)1 Apr 2020MP62-16 A PROSPECTIVE EVALUATION OF PELVIC LYMPH NODE STAGING WITH 18FLUORINE PROSTATE-SPECIFIC MEMBRANE ANTIGEN PET/CT PRIOR TO EXTENDED LYMPH NODE DISSECTION IN PRIMARY PROSTATE CANCER. THE SALT STUDY Yves J.L. Bodar*, B.H.E. Jansen, G.J.C. Zwezerijnen, J.A. Nieuwenhuijzen, M. Wondergem, T.A. Roeleveld, O.S. Hoekstra, R.J.A. van Moorselaar, D.E. Oprea-Lager, and A.N. Vis Yves J.L. Bodar*Yves J.L. Bodar* More articles by this author , B.H.E. JansenB.H.E. Jansen More articles by this author , G.J.C. ZwezerijnenG.J.C. Zwezerijnen More articles by this author , J.A. NieuwenhuijzenJ.A. Nieuwenhuijzen More articles by this author , M. WondergemM. Wondergem More articles by this author , T.A. RoeleveldT.A. Roeleveld More articles by this author , O.S. HoekstraO.S. Hoekstra More articles by this author , R.J.A. van MoorselaarR.J.A. van Moorselaar More articles by this author , D.E. Oprea-LagerD.E. Oprea-Lager More articles by this author , and A.N. VisA.N. Vis More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000937.016AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Accurate detection of pelvic lymph node metastases (N-stage) in patients with primary prostate cancer (PCa) is important for disease prognostics, therapeutic decisions, and follow-up. Radiolabelled Prostate-Specific Membrane Antigen PET/CT has been succesful for restaging PCa, yet its diagnostic accuracy for staging primary PCa is less established. Besides 68Gallium-labelled PSMA-tracers, 18Fluorine-labelled PSMA tracers are now available (e.g. 18F-DCFPyL). These tracers offer higher image-resolution and therefore potentially increased detection of metastases. This is the first large prospective study to examine the diagnostic accuracy of 18F-PSMA PET/CT (18F-DCFPyL) for lymph node metastases (N1) in patients with primary PCa. METHODS: This was a multicenter, prospective trial (2017-2019). Patients with primary PCa undergoing robot-assisted radical prostatectomy and extend pelvic lymph-node dissection (based on MSKCC nomogram risk ≥8% on N1) were included. All subjects underwent 18F-DCFPyL PET/CT (median 311 MBq) prior to surgery. Imaging results were correlated to histopathology after surgery (reference standard). The study has been approved by the IRB of the Amsterdam UMC (2017.543); all subjects signed informed consent. RESULTS: A total of 113 patients were included, of which 17 patients (15%) harboured lymph node metastases on pathological evaluation (N1). The sensitivity, specificity, positive predictive value and negative predictive value of 18F-PSMA PET/CT for N1 was 41% (CI 19%-66%), 94% (CI 86%-97%), 54% (CI 26%-79%) and 90% (CI 81%-94%), respectively. Interobserver agreement on imaging N-stage was 95% (CI 90-98%). Additionally, the detection of locally advanced tumour growth (T-stage 3-4) was evaluated, for which 18F-PSMA PET/CT had a sensitivity, specificity, PPV and NPV of 44% (CI 32-57%), 94% (CI 83%-98%), 90% (CI 72%-97%) and 59% (CI 47-69%). CONCLUSIONS: 18F-PSMA PET/CT has a high specificity (94%), yet a limited sensitivity (41%) for the detection of pelvic lymph node metastases in patients with primary PCa. Promising specificity for detection of locally-advanced tumour stages with 18F-PSMA PET/CT was observed. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e951-e952 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yves J.L. Bodar* More articles by this author B.H.E. Jansen More articles by this author G.J.C. Zwezerijnen More articles by this author J.A. Nieuwenhuijzen More articles by this author M. Wondergem More articles by this author T.A. Roeleveld More articles by this author O.S. Hoekstra More articles by this author R.J.A. van Moorselaar More articles by this author D.E. Oprea-Lager More articles by this author A.N. Vis More articles by this author Expand All Advertisement PDF downloadLoading ...