Mapping prostate cancer lesions pre/post unsuccessful salvage lymph node dissection using repeat PSMA-PET.

Farolfi, Andrea; Ilhan, Harun; Gafita, Andrei; Calais, Jeremie; Barbato, Francesco; Weber, Manuel; Afshar-Oromieh, Ali; Spohn, Fabian; Wetter, Axel; Rischpler, Christoph; Hadaschik, Boris; Pianori, Davide; Fanti, Stefano; Haberkorn, Uwe; Eiber, Matthias; Herrmann, Ken; Fendler, Wolfgang Peter (2020). Mapping prostate cancer lesions pre/post unsuccessful salvage lymph node dissection using repeat PSMA-PET. The journal of nuclear medicine, 61(7), pp. 1037-1042. Society of Nuclear Medicine and Molecular Imaging 10.2967/jnumed.119.235374

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Introduction: The aim of this study was to analyze patterns of persistent versus recurrent or new PET lesions in a selected patient cohort with PSA persistence following salvage lymph node dissection (SLND) and pre/post procedure prostate-specific membrane antigen ligand positron emission tomography (PSMA-PET). Material and Methods: 16 patients were included in this multicenter study. Inclusion criteria were: a) PSMA-PET performed for biochemical recurrence before SLND (pre-SLND PET) and b) repeat PSMA-PET performed for persistently elevated PSA level (≥0.1 ng/mL) ≥6 weeks after SLND (post-SLND PET). Image analysis was performed by three independent nuclear medicine physicians applying the molecular imaging TNM system PROMISE. Lesions were confirmed by histopathology, presence on correlative CT/MRI/bone scan or PSA response after focal therapy. Results: post-SLND PET identified PCa-lesions in 88% (14/16) of patients with PSA persistence after SLND. Median PSA was 1.2 ng/mL (IQR, 0.6-2.8 ng/mL). Disease was confined to the pelvis in 56% of patients (9/16) and most of these men had common iliac (6/16, 38%) and internal iliac lymph node metastases (6/16, 38%). Extrapelvic disease was detected in 31% of patients (5/16). In pre- and post-SLND PET comparison, 10/16 had at least one lesion already detected at baseline (63% PET persistence); 4/16 had new lesions only (25% PET recurrence); 2 had no disease on post-SLND PET. All validated regions (11 regions in 9 patients) were true positive. 9/14 (64%) patients underwent repeat local therapies after SLND (7/14 radiotherapy, 2/14 surgery). Conclusion: SLND of pelvic nodal metastases was often not complete according to PSMA-PET. About two thirds of patients had PET positive nodal disease after SLND already seen on pre-SLND PSMA-PET. Notably, about one quarter of patients had new lesions, not detected by pre-surgical PSMA-PET.

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