Pd50-07 Pet Psma Imaging for Evaluation of Recurrent or Persistent Prostate Cancer After Primary Prostate Radiation

You have accessJournal of UrologyProstate Cancer: Detection & Screening V (PD50)1 May 2024PD50-07 PET PSMA IMAGING FOR EVALUATION OF RECURRENT OR PERSISTENT PROSTATE CANCER AFTER PRIMARY PROSTATE RADIATION Richard Bennett, Eric V. Li, Austin Y. Ho, Jonathan Aguiar, Ashorne K. Mahenthiran, Sai Kumar, Zequn Sun, Chalairat Suk-ouichai, Clayton Neill, Hiten D. Patel, Edward M. Schaeffer, Hatice Savas, and Ashley E. Ross Richard BennettRichard Bennett , Eric V. LiEric V. Li , Austin Y. HoAustin Y. Ho , Jonathan AguiarJonathan Aguiar , Ashorne K. MahenthiranAshorne K. Mahenthiran , Sai KumarSai Kumar , Zequn SunZequn Sun , Chalairat Suk-ouichaiChalairat Suk-ouichai , Clayton NeillClayton Neill , Hiten D. PatelHiten D. Patel , Edward M. SchaefferEdward M. Schaeffer , Hatice SavasHatice Savas , and Ashley E. RossAshley E. Ross View All Author Informationhttps://doi.org/10.1097/01.JU.0001008620.35181.96.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PSMA PET is increasingly utilized for the evaluation of disease stage at biochemical recurrence. Here we evaluate the association of clinico-pathologic features with PSMA findings in biochemically recurrent patients after primary prostate radiation therapy (RT). METHODS: We queried the Northwestern Medical System Electronic Data Warehouse between July 2021 and March 2023 to identify 122 men treated with primary RT for presumptive localized prostate cancer who subsequently underwent Gallium-68 or F-18 piflufolastat (DCFPyL) PSMA PET/CT for staging. Patient characteristics, including demographic, clinical, pathological, and imaging variables were obtained. PSMA positivity for suspicious nodal or metastatic disease was determined based on radiology interpretation, with equivocal or likely benign lesions considered as negative findings. Clinical variables were compared using a Wilcoxon rank-sum and Fisher's exact tests. Regression analysis was performed to determine variables associated with PSMA positivity in biochemically recurrent patients. RESULTS: Among the 119 men staged with PET PSMA after RT, median PSA was 3.18 (IQR 1.35, 5.55 ng/mL). 78% (93/119) were found to have suspicious PSMA positive disease. 39% had PSMA positivity in the prostate only (46/119), 6.7% had pelvic nodal disease (8/119), and 33% had extrapelvic disease (39/119). On regression analysis, PSA at the time of PSMA was the only factor associated with PSMA positivity (OR 1.32 per 1 point increase, 95% CI 1.10, 1.67, p=0.01). Higher PSAs at the time of scan were additionally associated with distant recurrence (73.3% of men with distant recurrence if scanned at PSA >10 ng/mL versus 31.9% if scanned at PSA <4 ng/mL, p=0.029, Figure 1). 20% (9/46) of men with PSMA positivity within the prostate were biopsied identifying 78% (7/9) positivity, of which 67% (4/6) receiving treatment selected management with salvage treatments. CONCLUSIONS: Patients with prostate cancer initially treated with RT showed significant rates of PSMA positive disease even when scanned at low PSAs (including many below the nadir+2 ng/mL definition). Evaluation at low PSAs favors the identification of localized disease only which can be cured by salvage therapy if confirmed by biopsy (i.e. prostatectomy, cryoablation, HIFU). Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1059 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Richard Bennett More articles by this author Eric V. Li More articles by this author Austin Y. Ho More articles by this author Jonathan Aguiar More articles by this author Ashorne K. Mahenthiran More articles by this author Sai Kumar More articles by this author Zequn Sun More articles by this author Chalairat Suk-ouichai More articles by this author Clayton Neill More articles by this author Hiten D. Patel More articles by this author Edward M. Schaeffer More articles by this author Hatice Savas More articles by this author Ashley E. Ross More articles by this author Expand All Advertisement PDF downloadLoading ...