BACKGROUND: The role of local therapies including radical prostatectomy (RP) in prostate cancer (PCa) patients with clinical lymphadenopathies on prostate-specific membrane antigen (PSMA) positron emission tomography/computerized tomography (PET/CT) has scarcely been explored. Limited data are available to identify men who would benefit from RP; on the contrary, those more likely to benefit already have systemic disease. OBJECTIVE: We aimed to assess the predictors of prostate-specific antigen (PSA) persistence in surgically managed PCa patients with lymphadenopathies on a PSMA PET/CT scan by integrating clinical, magnetic resonance imaging (MRI), and PSMA PET/CT parameters. DESIGN, SETTING, AND PARTICIPANTS: We identified 519 patients treated with RP and extended lymph node dissection, and who received preoperative PSMA PET between 2017 and 2022 in nine referral centers. Among them, we selected 88 patients with nodal uptake at preoperative PSMA PET (miTxN1M0). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The outcome was PSA persistence, defined as a PSA value of ≥0.1 ng/ml at the first measurement after surgery. Multivariable logistic regression models tested the predictors of PSA persistence. Covariates consisted of biopsy International Society of Urological Pathology (ISUP) grade group, clinical stage at MRI, and number of positive spots at a PET/CT scan. A regression tree analysis stratified patients into risk groups based on preoperative characteristics. RESULTS AND LIMITATIONS: Overall, lymph node invasion (LNI) was detected in 63 patients (72%) and 32 (36%) experienced PSA persistence after RP. At multivariable analyses, having more than two lymph nodal positive findings at PSMA PET, seminal vesicle invasion (SVI) at MRI, and ISUP grade group >3 at biopsy were independent predictors of PSA persistence (all p < 0.05). At the regression tree analysis, patients were stratified in four risk groups according to biopsy ISUP grade, number of positive findings at PET/CT, and clinical stage at MRI. The model depicted good discrimination at internal validation (area under the curve 78%). CONCLUSIONS: One out of three miN1M0 patients showed PSA persistence after surgery. Patients with ISUP grade 2-3, as well as patients with organ-confined disease at MRI and a single or two positive nodal findings at PET are those in whom RP may achieve the best oncological outcomes in the context of a multimodal approach. Conversely, patients with a high ISUP grade and extracapsular extension or SVI or more than two spots at PSMA PET should be considered as potentially affected by systemic disease upfront. PATIENT SUMMARY: Our novel and straightforward risk classification integrates currently available preoperative risk tools and should, therefore, assist physician in preoperative counseling of men candidates for radical treatment for prostate cancer with positive lymph node uptake at prostate-specific membrane antigen positron emission tomography.

Department of Oncology Division of Urology San Luigi Gonzaga Hospital Turin Italy

Department of Urology Drum Tower Hospital Medical School of Nanjing University Institute of Urology Nanjing University Jiangsu China

Department of Urology Hospital Clinico San Carlos Madrid Spain

Department of Urology Luzerner Kantonsspital Luzern Switzerland

Department of Urology Medical University of Vienna Vienna Austria

Department of Urology Medical University of Vienna Vienna Austria; Department of Urology Medical University of Silesia Zabrze Poland

Department of Urology Medical University of Vienna Vienna Austria; Department of Urology Weill Cornell Medical College New York NY USA; Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic; Department of Urology University of Texas Southwestern Dallas TX USA; Division of Urology Department of Special Surgery The University of Jordan Amman Jordan

Department of Urology St Antonius Hospital Utrecht The Netherlands

Department of Urology St Antonius Hospital Utrecht The Netherlands; Department of Radiation Oncology University Medical Center Utrecht The Netherlands

Department of Urology University Hospitals Leuven Leuven Belgium

Department of Urology West German Cancer Center University of Duisburg Essen Germany; German Cancer Consortium University Hospital Essen Essen Germany

Department Surgery Oncology and Gastroenterology Urologic Unit University of Padova Padua Italy

Division of Urology IRCCS Azienda Ospedaliero Universitaria di Bologna Bologna Italy

German Cancer Consortium University Hospital Essen Essen Germany; Department of Nuclear Medicine University of Duisburg Essen Germany

Unit of Urology Division of Oncology Gianfranco Soldera Prostate Cancer Laboratory IRCCS San Raffaele Scientific Institute Milan Italy; Vita Salute San Raffaele University Milan Italy

Vita Salute San Raffaele University Milan Italy; Department of Nuclear Medicine IRCCS Ospedale San Raffaele Milan Italy

Citace poskytuje Crossref.org