Pd17-09 Development of a Novel Risk Stratification for Prostate Cancer Patients Candidate to Radical Prostatectomy Staged With Preoperative Psma-Pet: The Key Role of Molecular Imaging

You have accessJournal of UrologyProstate Cancer: Staging I (PD17)1 May 2024PD17-09 DEVELOPMENT OF A NOVEL RISK STRATIFICATION FOR PROSTATE CANCER PATIENTS CANDIDATE TO RADICAL PROSTATECTOMY STAGED WITH PREOPERATIVE PSMA-PET: THE KEY ROLE OF MOLECULAR IMAGING Francesco Barletta, Giorgio Gandaglia, Pawel Rajwa, Juan Gomez Rivas, Timo F. W. Soeterik, Lorenzo Bianchi, Luca Afferi, Claudia Kesch, Junlong Zhuang, Wolfgang Fendler, Giancarlo Marra, Daniele Amparore, Steven Joniau, Eugenio Brunocilla, Agostino Mattei, Fabrizio Dal Moro, Cristian Fiori, Francesco Porpiglia, Maria Picchio, Arturo Chiti, Roderick van den Bergh, Shahrok F. Shariat, Francesco Montorsi, and Alberto Briganti Francesco BarlettaFrancesco Barletta , Giorgio GandagliaGiorgio Gandaglia , Pawel RajwaPawel Rajwa , Juan Gomez RivasJuan Gomez Rivas , Timo F. W. SoeterikTimo F. W. Soeterik , Lorenzo BianchiLorenzo Bianchi , Luca AfferiLuca Afferi , Claudia KeschClaudia Kesch , Junlong ZhuangJunlong Zhuang , Wolfgang FendlerWolfgang Fendler , Giancarlo MarraGiancarlo Marra , Daniele AmparoreDaniele Amparore , Steven JoniauSteven Joniau , Eugenio BrunocillaEugenio Brunocilla , Agostino MatteiAgostino Mattei , Fabrizio Dal MoroFabrizio Dal Moro , Cristian FioriCristian Fiori , Francesco PorpigliaFrancesco Porpiglia , Maria PicchioMaria Picchio , Arturo ChitiArturo Chiti , Roderick van den BerghRoderick van den Bergh , Shahrok F. ShariatShahrok F. Shariat , Francesco MontorsiFrancesco Montorsi , and Alberto BrigantiAlberto Briganti View All Author Informationhttps://doi.org/10.1097/01.JU.0001010044.70939.31.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Preoperative risk stratifications are part of the clinical decision-making in prostate cancer (PCa) patients candidate for radical prostatectomy (RP). Although novel risk groups have been developed, no stratification scheme includes PET-PSMA information, which could identify patients more likely to experience biochemical failure (BCF). Thus, we aimed at developing a novel stratification tool in PCa patients staged with PET-PSMA. METHODS: Overall, 707 intermediate- or high-risk PCa treated with RP and extended pelvic lymph node dissection (ePLND) with a preoperative PSMA-PET at 9 centres between 2016-2023 were identified. Study outcome was early BCF after RP defined as PSA ≥0.1 at 6 weeks or increasing PSA ≥0.2 within 2 years after surgery. Kaplan-Meier (KM) plots and Multivariable Cox-regression (MCR) models adjusted for PSA (20 ng/ml), mpMRI non-organ-confined stage, biopsy grade group (GG; 1-2 vs 3 vs 4-5), percentage of positive biopsy cores (<50 vs ≥50%) and PET-PSMA findings (miN0 vs miN1) were used. A score was assigned to each feature according to Cox-derived coefficients. Patients were stratified in intermediate (0-2 points) vs high (3-5 points) vs very-high (≥6 points) risk groups. Discrimination was tested using Harrel's c-index. Decision curve analysis (DCA) determined the clinical net benefit associated with the new stratification scheme compared to available ones (namely, EAU rik groups, tool by Mazzone at al - Eur Urol. 2022;81:193-203). RESULTS: Median age and PSA were 67 and 8 ng/ml. When patients were categorized according to Mazzone vs EAU risk groups the distribution was as follows: 133 (19%) intermediate vs 508 (72%) high vs 66 (9%) very-high; and 229 (32%) intermediate vs 478 (68%) high risk. miN1 stage was present in 99 (14%) patients. At MCR, miN1 stage represented the strongest predictor for BCF (HR 3.9, 95%CI 2.5-5.9, p<0.001). After stratification according to Cox-derived scores, 277 (39%) intermediate vs 195 (28%) high vs 235 (33%) very-high-risk patients were identified. At KM, 2-yrs BCF rates were 91% for intermediate vs 79% for high vs 58% for very-high-risk patients, according to the novel risk groups. This stratification depicted better discrimination compared to EAU and Mazzone classifications (c-index: 73 vs 60 vs 61%). In DCA, the novel risk stratification exhibited higher net-benefit compared to the available ones. CONCLUSIONS: A newly developed tool including PSMA PET outperformed available risk groups to predict early BCF after surgery. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e373 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Francesco Barletta More articles by this author Giorgio Gandaglia More articles by this author Pawel Rajwa More articles by this author Juan Gomez Rivas More articles by this author Timo F. W. Soeterik More articles by this author Lorenzo Bianchi More articles by this author Luca Afferi More articles by this author Claudia Kesch More articles by this author Junlong Zhuang More articles by this author Wolfgang Fendler More articles by this author Giancarlo Marra More articles by this author Daniele Amparore More articles by this author Steven Joniau More articles by this author Eugenio Brunocilla More articles by this author Agostino Mattei More articles by this author Fabrizio Dal Moro More articles by this author Cristian Fiori More articles by this author Francesco Porpiglia More articles by this author Maria Picchio More articles by this author Arturo Chiti More articles by this author Roderick van den Bergh More articles by this author Shahrok F. Shariat More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...