PSMA-ligand uptake can serve as a novel biomarker in primary prostate cancer to predict outcome after radical prostatectomy

Abstract Background The prostate-specific membrane antigen (PSMA) is a relevant target in prostate cancer, and immunohistochemistry studies showed associations with outcome. PSMA-ligand positron emission tomography (PET) is increasingly used for primary prostate cancer staging, and the molecular imaging TNM classification (miTNM) standardizes its reporting. We aimed to investigate the potential of PET-imaging to serve as a noninvasive imaging biomarker to predict disease outcome in primary prostate cancer after radical prostatectomy (RP). Methods In this retrospective analysis, 186 primary prostate cancer patients treated with RP who had undergone a 68Ga-PSMA-11 PET up to three months prior to the surgery were included. Maximum standardized uptake value (SUVmax), SUVmean, tumor volume (TV) and total lesion (TL) were collected from PET-imaging. Moreover, clinicopathological information, including age, serum prostate-specific antigen (PSA) level, and pathological characteristics, was assessed for disease outcome prediction. A stage group system for PET-imaging findings based on the miTNM framework was developed. Results At a median follow-up after RP of 38 months (interquartile range (IQR) 22–53), biochemical recurrence (BCR) was observed in 58 patients during the follow-up period. A significant association between a positive surgical margin and miN status (miN1 vs. miN0, odds ratio (OR): 5.428, p = 0.004) was detected. miT status (miT ≥ 3a vs. miT < 3, OR: 2.696, p = 0.003) was identified as an independent predictor for Gleason score (GS) ≥ 8. Multivariate Cox regression analysis indicated that PSA level (hazard ratio (HR): 1.024, p = 0.014), advanced GS (GS ≥ 8 vs. GS < 8, HR: 3.253, p < 0.001) and miT status (miT ≥ 3a vs. miT < 3, HR: 1.941, p = 0.035) were independent predictors for BCR. For stage I disease as determined by PET-imaging, a shorter BCR-free survival was observed in the patients with higher SUVmax (IA vs. IB stage, log-rank, p = 0.022). Conclusion Preoperative miTNM classification from 68Ga-PSMA-11 PET correlates with postoperative GS, surgical margin status and time to BCR. The association between miTNM staging and outcome proposes 68Ga-PSMA-11 PET as a novel non-invasive imaging biomarker and potentially serves for ancillary pre-treatment stratification.

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PSMA-Ligand Uptake Can Serve as a Novel Biomarker in Primary Prostate Cancer to Predict Outcome After Radical Prostatectomy

10.21203/rs.3.rs-603830/v1 ◽

2021 ◽

Author(s):

Hui Wang ◽

Thomas Amiel ◽

Christoph Würnschimmel ◽

Thomas Langbein ◽

Katja Steiger ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Cancer Patients ◽

Pet Imaging ◽

Surgical Margin ◽

Disease Outcome ◽

Imaging Biomarker ◽

Psma Ligand ◽

Primary Prostate Cancer

Abstract BackgroundThe prostate-specific membrane antigen (PSMA) is a relevant target in prostate cancer and immunohistochemistry studies showed associations with outcome. PSMA-ligand positron emission tomography (PET) is increasingly used for primary prostate cancer staging and the molecular imaging TNM classification (miTNM) standardizes its reporting. We aimed to investigate the potential of PET-imaging to serve as a noninvasive imaging biomarker to predict disease outcome in primary prostate cancer after radical prostatectomy (RP).MethodsIn this retrospective analysis, 186 primary prostate cancer patients treated with RP who had undergone a 68Ga-PSMA-11 PET up to three months prior to the surgery were included. Maximum standardized uptake value (SUVmax), SUVmean, tumor volume (TV) and total lesion (TL) were collected from PET-imaging. Moreover, clinicopathological information, including age, serum prostate-specific antigen (PSA) level, and pathological characteristics were assessed for disease outcome prediction. A stage group system for PET-imaging findings based on the miTNM framework was developed. ResultsAt a median follow-up after RP of 38 months (interquartile range (IQR): 22-53), biochemical recurrence (BCR) was observed in 58 patients during the follow-up period. A significant association between a positive surgical margin and miN status (miN1 vs. miN0, odds ratio (OR): 5.428, p=0.004) was detected. miT status (miT≥3a vs. miT<3, OR: 2.696, p=0.003) was identified as an independent predictor for Gleason score (GS)≥8. Multivariate Cox regression analysis indicated that PSA level (hazard ratio (HR): 1.024, p=0.014), advanced GS (GS≥8 vs. GS<8, HR: 3.253, p<0.001) and miT status (miT≥3a vs. miT<3, HR: 1.941, p=0.035) were independent predictors for BCR. For stage I disease as determined by PET-imaging a shorter BCR-free survival was observed in the patients with higher SUVmax (IA vs. IB stage, log-rank, p=0.022).ConclusionPreoperative miTNM classification from 68Ga-PSMA-11 PET correlates with postoperative GS, surgical margin status and time to BCR. The association between miTNM staging and outcome proposes 68Ga-PSMA-11 PET as a novel non-invasive imaging biomarker and potentially serves for ancillary pre-treatment stratification. Prospective studies with larger cohort are necessary to fully determine its use including primary prostate cancer patients with different treatments and risk categories and late-stage patients.

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Tumor contact length used as a biomarker to predict extracapsular extension, lymph node involvement, and biochemical recurrence.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e16588 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e16588-e16588

Author(s):

Públio Viana ◽

Thiana Rodrigues ◽

Davi alves martins Mota ◽

Giuliano Guglielmetti ◽

Diogo Assed Bastos ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Magnetic Resonance ◽

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Specific Antigen ◽

Contact Length ◽

Imaging Biomarker ◽

Exclusion Criterion

e16588 Background: Prostate cancer (PC) is the cancer most commonly diagnosed in men and the second leading cause of death. Multiparametric magnetic resonance imaging (mpMRI) is the benchmark imaging standard for local staging of PC. Patients with pathological extraprostatic tumor (pEPE) have a worse prognosis than those with confined organ disease with a higher risk of biochemical recurrence (BCR) after radical prostatectomy (RP). These factors, in addition to positive lymph nodes (PLN), are pivotal in the decision-making process regarding treatment. However, the subjective MRI analysis has low sensitivity in the detection of EPE and is plagued by the low interobserver agreement. Tumor contact length (TCL) is an objective parameter of mpMRI defined as the length of prostate cancer in contact with the prostate capsule, which may provide additional information about prostate cancer outcomes. We aimed to evaluate TCL as a predictor of pECE, PLN, and BCR in patients undergoing RP. Methods: In this Institutional Review Board approved single-institution prospective study, we update the follow-up of 148 patients and included 31 new patients, with prostate cancer who underwent prostate MRI before radical prostatectomy from March 2014 to november 2018. TCL was measured using T2-weighted magnetic resonance images.Postoperative prostate-specific antigen (PSA) values were obtained every 3 months in the first year, then biannually and annually thereafter. BCR was defined as PSA≥0.2ng/mL. The exclusion criterion was prior treatment. Results: The median follow-up was 44 months. 76/179 (42,4%) patients had pEPE, 12/179 (6,7%) had pLN, and 29/179 (16,2%) had BCR. TCL values were significantly higher in patients with pathological pECE ( 20,6 mm vs 9,9 mm, p < 0.001). Using a cut-off of 11,9 mm we found area under curve (AUC) of 0,71 to predict pathological ECE, with sensitivity 72,5% and specificity 67,5% . Using a cut-off of 16,5 mm we found AUC of 0,64 to predict BCR, with sensitivity 54,2% and specificity 67,8% and with a cut-off of 21,7 mm the AUC to predict PLN was 0,77, with sensitivity 66,7% and specificity 83,6%. Conclusions: We prospectively demonstrated in our population that TCL values were significantly higher in patients with pEPE , PLN and BCR. If validated, this imaging biomarker may facilitate and inform patient counseling and decision-making.

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565 Probability of positive PET imaging with a [68Ga]-labelled PSMA ligand based on PSA value in patients with biochemical recurrent prostate cancer after radical prostatectomy

European Urology Supplements ◽

10.1016/s1569-9056(16)60567-5 ◽

2016 ◽

Vol 15 (3) ◽

pp. e565 ◽

Cited By ~ 1

Author(s):

L. Cromphout ◽

L. Tosco ◽

W. Everaerts ◽

M. Albersen ◽

O. Gheysens ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Pet Imaging ◽

Recurrent Prostate Cancer ◽

Psma Ligand

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Risk of recurrence in patients with positive surgical margin at apex only versus other locations after radical prostatectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.124 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 124-124

Author(s):

Masashi Kato ◽

Akiyuki Yamamoto ◽

Ryo Ishida ◽

Tohru Kimura ◽

Tomoyasu Sano ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Adjuvant Therapy ◽

Surgical Margin ◽

Operative Approach ◽

Positive Surgical Margin ◽

Grade Group ◽

Clinical Recurrence ◽

Prostate Cancer Death

124 Background: Some reported that positive surgical margin at radical prostatectomy (RP) was a prognostic factor of clinical recurrence and prostate cancer death, and others showed that was not necessarily true. The prostatic apex is most popular location of positive surgical margin at RP and the frequency of apex is reported to be about 20-40% of all positive cases. Prostatic apex is also reported to lack a well-defined capsule and to be hardly retracted during operation. In this study, we evaluated the effect of positive surgical margin at apex-only on prognosis after RP in a large cohort. Methods: We retrospectively evaluated 1019 patients with prostate cancer who underwent radical prostatectomy without neoadjuvant or adjuvant therapy at the hospitals that the authors were affiliated with between 2005 and 2013. The operative approach (open, laparoscopic, or robotic) was decided by each institution. All prostatectomy specimen slides were reviewed by a single genitourinary pathologist according to ISUP 2014 criteria. Recurrence following RP was defined according to AUA guidelines. Results: The median patient age was 67 (range, 45–80) years. The median initial PSA was 6.8 ng/ml (range, 0.4–82 ng/ml). The median follow-up period was 69 (range, 0.7–135) months. Pathological T stage was in 72.5% of pT2 (n = 739), 23.4% of pT3a (n = 238), and 4.1% of pT3b (n = 42). There were 163 Grade Group (GG) 1 cases, 502 GG 2, 217 GG 3, 39 GG 4, and 98 GG 5 cases. 372 cases had positive surgical margin. Details were 201 (54%) apex only, 57 (15%) anterior, 43 (12%) posterior, 76 (20%) lateral, 40 (11%) bladder. Some patients showed multiple positive surgical margin. The patients with positive surgical margin at apex-only showed significantly better prognosis than other locations (P = 0.0001). This result was confirmed in each operative approach (open; P = 0.008, laparoscopic; P = 0.001, robotic; P = 0.01). Conclusions: Among surgical margin positive patients after RP, those at prostatic apex-only showed lower biochemical recurrence than other locations regardless of operative approach. Physician should follow such a patient carefully without adjuvant therapy.

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Clinical predictors for biochemical failure in patients with positive surgical margin after robotic-assisted radical prostatectomy

Tumori Journal ◽

10.1177/03008916211007928 ◽

2021 ◽

pp. 030089162110079

Author(s):

Shih-Huan Su ◽

Ying-Hsu Chang ◽

Liang-Kang Huang ◽

Yuan-Cheng Chu ◽

Hung-Cheng Kan ◽

...

Keyword(s):

Radical Prostatectomy ◽

Cox Regression ◽

Specific Antigen ◽

Surgical Margin ◽

Biochemical Failure ◽

Positive Surgical Margin ◽

Cox Regression Analysis ◽

Robotic Assisted ◽

Robotic Assisted Radical Prostatectomy

Objective: Patients with positive surgical margins (PSMs) after radical prostatectomy for localized prostate cancer have a higher risk of biochemical failure (BCF). We investigated the risk factors of BCF in patients with PSMs after robotic-assisted radical prostatectomy (RARP). Methods: We evaluated 462 patients who underwent RARP in a single medical center from 2006 through 2013. Of them, 61 with PSMs did not receive any treatment before BCF. Kaplan-Meier curve and Cox regression analysis were used to compare patients with (n = 19) and without (n = 41) BCF. Results: Overall, 13.2% of patients had PSMs, and of those, 31.7% experienced BCF during follow-up. The mean follow-up duration was 43.7 months (42.4 [non-BCF] vs 46.35 (BCF], p = 0.51). In univariant analyses, the platelet to lymphocyte ratio (6.26 [non-BCF] vs 8.02 [BCF], p = 0.04) differed statistically. When patients were grouped by pathologic grade ≦2 or ≧3 ( p = 0.004), the BCF-free survival rates differed significantly. Seminal vesicle invasion also differed significantly (5 [non-BCF] vs 7 [BCF], p = 0.005). Patients with undetectable nadir prostate-specific antigen (PSA) after RARP (BCF rate 4/34) differed statistically from those with detectable PSA after RARP (BCF rate 15/26) ( p < 0.001). In the multivariate analysis, the platelet/lymphocyte (P/L) ratio, pathologic grade, and undetectable nadir PSA remained statistically significant. Conclusions: In patients who undergo RARP and have PSMs, P/L ratio >9 preoperatively, pathologic grade ⩾3, and detectable nadir PSA after RARP should be considered adverse features. Early intervention such as salvage radiation therapy or androgen deprivation therapy should be offered to these patients.

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Contrast-enhanced transrectal ultrasound can reduce collection of unnecessary biopsies when diagnosing prostate cancer and is predictive of biochemical recurrence following a radical prostatectomy in patients with localized prostate cancer

10.21203/rs.2.12072/v2 ◽

2020 ◽

Author(s):

Hong-wei Zhao ◽

Jian Li ◽

Jia-Zheng Cao ◽

Juan Lin ◽

Zhu Wang ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Cancer Diagnosis ◽

Biochemical Recurrence ◽

Transrectal Ultrasound ◽

Localized Prostate Cancer ◽

Prostate Cancer Diagnosis ◽

Cox Regression Analysis ◽

Contrast Enhanced

Abstract Background: To investigate the value of using contrast-enhanced transrectal ultrasound (CETRUS) to reduce unnecessary collection of biopsies during prostate cancer diagnosis and its utility in predicting biochemical recurrence in patients with localized prostate cancer. Methods: This was a prospective study of suspected prostate cancer patients who were evaluated with CETRUS followed by a prostate biopsy. Prostate blood flow via CETRUS was graded using a 5-point scale. The relationship between CETRUS score and biopsy outcome was then analyzed for all patients; univariate and multi-variate analyses were used to determine the probable prognostic factors for biochemical recurrence in patients with localized prostate cancer that underwent a radical prostatectomy. Results: A total of 347 patients were enrolled in the study. Prostate cancer was found in 164 patients. A significant positive correlation (r = 0.69, p < 0.001) was found between CETRUS scores and prostate cancer incidence. Using CETRUS scores ≥ 2 as the threshold for when to biopsy could have safely reduced the number of biopsies taken overall by 12.1% (42/347) and spared 23.0% (42/183) of patients from undergoing an unnecessary biopsy. 77 patients with localized prostate cancer underwent a radical prostatectomy. The median follow-up time was 30 months (range: 8-56 months) and 17 of these 77 patients exhibited biochemical recurrence during the follow-up period. 3-year biochemical recurrence-free survival rates were 86% for patients with low CETRUS scores (≤ 3) and 59% for patients with high scores (> 3; p = 0.015). Multivariate Cox regression analysis indicated that CETRUS score was an independent predictor of biochemical recurrence (HR: 7.02; 95% CI: 2.00-24.69; p = 0.002). Conclusions: CETRUS scores may be a useful tool for reducing the collection unnecessary biopsy samples during prostate cancer diagnosis and are predictive of biochemical recurrence in patients with localized prostate cancer following a radical prostatectomy.

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