Mp61-12 which men with cn1 prostate cancer at psma pet/ct represent the ideal candidate to radical prostatectomy? development of a novel risk stratification tool for individualized approaches based on a large, multi-institutional series

You have accessJournal of UrologyCME1 Apr 2023MP61-12 WHICH MEN WITH CN1 PROSTATE CANCER AT PSMA PET/CT REPRESENT THE IDEAL CANDIDATE TO RADICAL PROSTATECTOMY? DEVELOPMENT OF A NOVEL RISK STRATIFICATION TOOL FOR INDIVIDUALIZED APPROACHES BASED ON A LARGE, MULTI-INSTITUTIONAL SERIES Francesco Barletta, Elio Mazzone, Giorgio Gandaglia, Lorenzo Bianchi, Riccardo Schiavina, Luca Afferi, Agostino Mattei, Fabio Zattoni, Giuseppe Reitano, Pawel Rajwa, Shahrok Shariat, Claudia Kesch, Juan Gomez Rivas, Giancarlo Marra, Hongqian Guo, Junlong Zhuang, Daniele Amparore, Francesco Porpiglia, Nicolai Huebner, Eugenio Brunocilla, Enrico Checcucci, Fabrizio Dal Moro, Jesus Moreno-Sierra, Christopher Darr, Alida Sartorello, Francesco Montorsi, and Alberto Briganti Francesco BarlettaFrancesco Barletta More articles by this author , Elio MazzoneElio Mazzone More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Lorenzo BianchiLorenzo Bianchi More articles by this author , Riccardo SchiavinaRiccardo Schiavina More articles by this author , Luca AfferiLuca Afferi More articles by this author , Agostino MatteiAgostino Mattei More articles by this author , Fabio ZattoniFabio Zattoni More articles by this author , Giuseppe ReitanoGiuseppe Reitano More articles by this author , Pawel RajwaPawel Rajwa More articles by this author , Shahrok ShariatShahrok Shariat More articles by this author , Claudia KeschClaudia Kesch More articles by this author , Juan Gomez RivasJuan Gomez Rivas More articles by this author , Giancarlo MarraGiancarlo Marra More articles by this author , Hongqian GuoHongqian Guo More articles by this author , Junlong ZhuangJunlong Zhuang More articles by this author , Daniele AmparoreDaniele Amparore More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , Nicolai HuebnerNicolai Huebner More articles by this author , Eugenio BrunocillaEugenio Brunocilla More articles by this author , Enrico CheccucciEnrico Checcucci More articles by this author , Fabrizio Dal MoroFabrizio Dal Moro More articles by this author , Jesus Moreno-SierraJesus Moreno-Sierra More articles by this author , Christopher DarrChristopher Darr More articles by this author , Alida SartorelloAlida Sartorello More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003319.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Limited data is available to identify men who would benefit the most from radical prostatectomy (RP) in prostate cancer (PCa) patients with clinical lymphadenopathies (cN+) at PSMA PET and, on the other hand, to select patients for proper management. We aimed at assessing predictors of early recurrence in surgically managed PCa patients with cN+at PSMA PET scan by integrating clinical, magnetic resonance imaging (MRI) and PET parameters. METHODS: We identified 662 patients treated with RP and lymph node dissection who received preoperative PSMA PET between 2017 and 2022 at nine referral Centers. We selected 93 patients with positive nodal uptake at preoperative PSMA PET. The study outcome was PSA persistence, defined as a PSA≥0.1ng/ml at first postoperative measurement. Multivariable logistic regression tested predictors of persistence. Covariates consisted of biopsy ISUP grade group (IGG) (2-3 vs 4-5), stage at MRI (organ-confined disease [OC] vs. extracapsular extension [ECE] vs. seminal vesicles invasion [SVI)) and number of positive spots at PET scan. Regression tree analysis stratified patients into risk groups based on their preoperative characteristics. RESULTS: Median number of positive spots at preoperative PET was 2. LNI was detected in 64 patients (69%). Comparing PSMA PET and final pathology, concordance of positive nodes location was 85%. 32 patients (34%) experienced PSA persistence after RP. At multivariable analyses, biopsy IGG 4-5 represented the strongest predictor of PSA persistence (OR: 2.44; p=0.001). At regression tree analysis, patients were stratified in four risk group according to IGG, number of positive spots at PET and stage at MRI (Figure 1). This model depicted a good discrimination (AUC 78%). Notably, patients in high and very-high risk groups showed higher PSA persistence (62 and 83%, respectively) compared to low-risk group (27%). CONCLUSIONS: Patients with IGG 2-3, as well as patients with IGG 4-5 but with OC or ECE at MRI and a single positive spot at PET are those where RP may achieve the best oncological. Conversely, patients with high GG and SVI or>1 spots at PSMA PET should be considered as potentially affected by a systemic disease upfront. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e857 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francesco Barletta More articles by this author Elio Mazzone More articles by this author Giorgio Gandaglia More articles by this author Lorenzo Bianchi More articles by this author Riccardo Schiavina More articles by this author Luca Afferi More articles by this author Agostino Mattei More articles by this author Fabio Zattoni More articles by this author Giuseppe Reitano More articles by this author Pawel Rajwa More articles by this author Shahrok Shariat More articles by this author Claudia Kesch More articles by this author Juan Gomez Rivas More articles by this author Giancarlo Marra More articles by this author Hongqian Guo More articles by this author Junlong Zhuang More articles by this author Daniele Amparore More articles by this author Francesco Porpiglia More articles by this author Nicolai Huebner More articles by this author Eugenio Brunocilla More articles by this author Enrico Checcucci More articles by this author Fabrizio Dal Moro More articles by this author Jesus Moreno-Sierra More articles by this author Christopher Darr More articles by this author Alida Sartorello More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...