PSA and PET Combination for Selecting sLND Candidates in Recurrent Prostate Cancer

What is it about?

In this study, the relationship between pre-operative PSA value, 68 Ga-prostate-specific-membrane-antigen (PSMA) PET performance and oncologic outcomes after salvage lymph node dissection (sLND) for biochemical recurrent prostate cancer (PCa) was evaluated. A total of 164 patients diagnosed with ≤2 pelvic lymph-node recurrence(s) of PCa documented on 68 Ga-PSMA PET scan and treated with pelvic AE retroperitoneal sLND at 11 high-volume centres between 2012 and 2019 were included. The rate of positive pathology increased as a function of pre-operative PSA value. After sLND, PSA ≤ 0.3 ng/ml was detected in 67 (41%) men. On multivariable analyses, pre-operative PSA was associated with PSA response (p < 0.0001). There were 51 CRs after sLND. Despite higher rates of PSA response after sLND, patients receiving sLND at lower PSA levels had worse CR-free survival than those treated at PSA level ≥1 ng/ml. These findings might help physicians to optimize the timing for restaging imaging in biochemical recurrent prostate cancer.

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Why is it important?

This research is important because it helps to understand the relationship between pre-operative PSA value, 68 Ga-prostate-specific-membrane-antigen (PSMA) PET performance, and oncologic outcomes after salvage lymph node dissection (sLND) for biochemical recurrent prostate cancer (PCa). This information can help optimize the timing for restaging imaging in biochemical recurrent prostate cancer, which can ultimately improve patient outcomes. Key Takeaways: 1. The study included 164 patients diagnosed with ≤2 pelvic lymph-node recurrence(s) of PCa documented on 68 Ga-PSMA PET scan and treated with pelvic AE retroperitoneal sLND at 11 high-volume centers between 2012 and 2019. 2. The rate of positive pathology increased as a function of pre-operative PSA value, with the highest rates for patients with preoperative PSA > 1.5 ng/ml. 3. Patients receiving sLND at lower PSA levels had worse CR-free survival than those treated at PSA level ≥1 ng/ml. 4. Despite higher rates of PSA response after sLND, patients with pre-operative PSA value <1 ng/ml had a lower probability of achieving a PSA response after sLND.