Mp14-18 Oncological Outcomes of Pn1 Prostate Cancer Patients Treated With Radical Prostatectomy: Does Molecular Imaging Have a Prognostic Impact? Results of a Large, Multi-Institutional Series

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) II (MP14)1 May 2024MP14-18 ONCOLOGICAL OUTCOMES OF PN1 PROSTATE CANCER PATIENTS TREATED WITH RADICAL PROSTATECTOMY: DOES MOLECULAR IMAGING HAVE A PROGNOSTIC IMPACT? RESULTS OF A LARGE, MULTI-INSTITUTIONAL SERIES Francesco Barletta, Giorgio Gandaglia, Pawel Rajwa, Juan Gomez Rivas, Luca Afferi, Claudia Kesch, Christopher Darr, Junlong Zhuang, Fabio Zattoni, Helena Lanzafame, Giancarlo Marra, Nicolai Huebner, Steven Joniau, Eugenio Brunocilla, Agostino Mattei, Cristian Fiori, Cabrera Maria, Enrico Checcucci, Maria Picchio, Arturo Chiti, Roderick van den Bergh, Shahrok Shariat, Francesco Montorsi, and Alberto Briganti Francesco BarlettaFrancesco Barletta , Giorgio GandagliaGiorgio Gandaglia , Pawel RajwaPawel Rajwa , Juan Gomez RivasJuan Gomez Rivas , Luca AfferiLuca Afferi , Claudia KeschClaudia Kesch , Christopher DarrChristopher Darr , Junlong ZhuangJunlong Zhuang , Fabio ZattoniFabio Zattoni , Helena LanzafameHelena Lanzafame , Giancarlo MarraGiancarlo Marra , Nicolai HuebnerNicolai Huebner , Steven JoniauSteven Joniau , Eugenio BrunocillaEugenio Brunocilla , Agostino MatteiAgostino Mattei , Cristian FioriCristian Fiori , Cabrera MariaCabrera Maria , Enrico CheccucciEnrico Checcucci , Maria PicchioMaria Picchio , Arturo ChitiArturo Chiti , Roderick van den BerghRoderick van den Bergh , Shahrok ShariatShahrok Shariat , Francesco MontorsiFrancesco Montorsi , and Alberto BrigantiAlberto Briganti View All Author Informationhttps://doi.org/10.1097/01.JU.0001009428.69695.82.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nodal metastases (pN1) represent a predictor of adverse cancer control outcomes in prostate cancer (PCa) patients treated with radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND). Among pN1 patients, cN status has not been shown to impact on cancer control in the conventional imaging era. However, it is unclear whether these findings are applicable to patients staged with PSMA. We tested whether the presence of PSMA-PET nodal lesions (miN1) and their number have a prognostic impact in pN1 patients. METHODS: Overall, we retrieved 106 pN1 PCa patients with preoperative PSMA-PET treated with RP+ePLND without neoadjuvant therapies at 9 referral centres between 2016-2023. Study outcome was biochemical failure (BCF) after RP defined as a PSA value≥0.1 ng/ml at 6-week or two consecutive PSA values ≥0.2 ng/ml. Kaplan-Meier (KM) plots depicted BCF-free survival. Multivariable Cox-regression (MCR) models were fitted to test for the impact of miN1 stage and nodal burden at PSMA-PET (0 vs ≥1; 0 vs 1 vs ≥2) on BCF. In MCR models covariates consisted of: PSA at diagnosis, biopsy grade group (GG; 1-3 vs 4 vs 5), and MRI stage (organ-confined vs extracapsular-extension vs seminal vesicles invasion). Accuracy of MCR models without (model 1) vs including PET-PSMA information (model 2) vs stratifying PSMA-PET results according to number of nodal lesions (0 vs 1 vs ≥2, model 3) were assessed with models derived C-index. RESULTS: Median age and PSA at diagnosis were 67 (62-71) and 10 (7-22) ng/ml. A total of 50 (47%) patients had miN1 disease, with 21 (42%) vs 29 (58%) of these exhibiting 1 vs ≥2 lesions. The 2-yr BCF-free rates were 48% for miN0 vs 29% for miN1 patients. In MCR models miN1 stage (HR: 2.6, 95% CI 1.4-4.9, p=0.003) achieved independent predictor status for higher BCF risk. When stratifying patients according to the number (0 vs 1 vs ≥2) of suspicious nodal lesions at PSMA-PET, only the presence of ≥2 nodal lesions achieved independent predictor status for BCF (HR: 5.4, 95% CI 2.4-12.2, p<0.001). MCR models derived C-index were respectively 68 (model 1) vs 77 (model 2) vs 84% (model 3). CONCLUSIONS: In pN1 patients, the presence of visible nodal lesions at PSMA-PET is associated with BCF after RP+ePLND. Inclusion of information on PSMA-PET nodal burden increased the accuracy of MCR models predicting BCF. Presence of multiple PSMA-PET uptakes in the pelvis, but not a single positive spot, was associated with adverse cancer control and might prompt the use of early intensification approaches. Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e227 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 Luca Afferi More articles by this author Claudia Kesch More articles by this author Christopher Darr More articles by this author Junlong Zhuang More articles by this author Fabio Zattoni More articles by this author Helena Lanzafame More articles by this author Giancarlo Marra More articles by this author Nicolai Huebner 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 Cristian Fiori More articles by this author Cabrera Maria More articles by this author Enrico Checcucci 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 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 ...