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| The Journal of urology. 2020 Feb 18. doi: 10.1097/JU.0000000000000800 |
| Underestimation of PET/CT Scan in Assessing Tumour Burden of Men With Nodal Recurrence From Prostate Cancer: Head-to-Head Comparison OF Ga-PSMA and C-Choline in a Large, Multi-Institutional Series of Extended Salvage Lymph Node Dissections. |
| Fossati N1, Scarcella S2, Gandaglia G3, Suardi N4, Robesti D5, Boeri L6, Karnes RJ7, Heidenreich A8, Pfister D9, Kretschmer A10, Buchner A11, Stief C12, Battaglia A13, Joniau S14, Van Poppel H15, Osmonov D16, Juenemann KP17, Shariat S18, Hiester A19, Nini A20, Albers P21, Tilki D22, Graefen M23, Gill IS24, Mottrie A25, Galosi AB26, Montorsi F27, Briganti A28 |
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Abstract INTRODUCTION: The aim of the study was to compare C-Choline and Ga-PSMA in men undergoing SLND for nodal recurrent PCa. MATERIALS AND METHODS: The study included 641 patients who experienced PSA rise and nodal recurrence after radical prostatectomy and underwent SLND. Lymph node recurrence was documented by PET/CT scan using either C-Choline (n=407; 63%) or Ga-PSMA ligand (n=234; 37%). The outcome was underestimation of tumour burden (difference between number of positive nodes on final pathology and number of positive spots at PET/CT). Multivariable analysis tested the association between PET/CT tracer (C-Choline vs. Ga-PSMA) and underestimation of tumour burden. RESULTS: Overall, the extent of underestimation of tumour burden was significantly higher in the C-Choline group compared to the Ga-PSMA (p<0.0001). This was confirmed on multivariable analysis (p=0.028). Repeating these analyses according to PSA, the underestimation of tumour burden was lower with Ga-PSMA only when the PSA was ≤1.5 ng/ml. Conversely, the underestimation of the two tracers became similar when PSA was >1.5 ng/ml. Furthermore, we evaluated the risk of underestimation by number of positive spots on PET/CT scan. The higher the number of positive spots the higher the underestimation of tumour burden regardless of the tracer used (p=0.2). CONCLUSIONS: PET/CT scan significantly underestimates the burden of PCa recurrence, regardless of the tracer used. Ga-PSMA was associated with a lower rate of underestimation in patients with a PSA below 1.5 ng/ml and a limited nodal tumour load. In all other men, there was no benefit from Ga-PSMA over C-Choline in assessing the extent of nodal recurrence. |
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KEYWORDS: Lymph Node Excision, Neoplasm Recurrence, Positron Emission Tomography Computed Tomography, Prostatic Neoplasms, Salvage Therapy |
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Publikations ID: 32068488 Quelle: öffnen |
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