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A retrospective study assessing the accuracy of [18F]–fluorocholine PET/CT for primary staging of lymph node metastases in intermediate and high-risk prostate cancer patients undergoing robotic-assisted laparoscopic prostatectomy with extended lymph node dissection

Puterman, Christopher ; Bjöersdorff, Mimmi LU orcid ; Amidi, Jennifer ; Anand, Aseem LU ; Soller, Wolfgang LU ; Jiborn, Thomas LU ; Kjölhede, Henrik LU ; Trägårdh, Elin LU and Bjartell, Anders LU (2021) In Scandinavian Journal of Urology 55(4). p.293-297
Abstract

Background: Previous studies have investigated [18F]-fluorocholine (FCH) positron emission tomography with computed tomography (PET/CT) in primary staging of men with intermediate or high-risk prostate cancer and have generally shown high specificity and poor sensitivity. FCH PET/CT is not recommended for the primary staging of metastases in the European guidelines for prostate cancer. However, it has been an option in the Swedish recommendations. Our aim was to assess PET/CT for primary staging of lymph node metastases before robotic-assisted laparoscopic prostatectomy (RALP) with extended pelvic lymph node dissection (ePLND) in patients with intermediate or high-risk prostate cancer. Method: We identified all men with prostate cancer... (More)

Background: Previous studies have investigated [18F]-fluorocholine (FCH) positron emission tomography with computed tomography (PET/CT) in primary staging of men with intermediate or high-risk prostate cancer and have generally shown high specificity and poor sensitivity. FCH PET/CT is not recommended for the primary staging of metastases in the European guidelines for prostate cancer. However, it has been an option in the Swedish recommendations. Our aim was to assess PET/CT for primary staging of lymph node metastases before robotic-assisted laparoscopic prostatectomy (RALP) with extended pelvic lymph node dissection (ePLND) in patients with intermediate or high-risk prostate cancer. Method: We identified all men with prostate cancer undergoing FCH PET/CT for initial staging followed by RALP and ePLND at Skåne University Hospital between 2015 and 2018. The result from PET/CT scan was compared with pathology report as the reference method for calculation of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: In total, 252 patients were included in the final analysis. Among 85 patients with a suspicion of regional lymph node metastases on FCH PET/CT only 31 had pathology-proven metastases. The sensitivity was 43% (95% CI 0.32–0.55) and the specificity 70% (95% CI 0.63–0.76) for PET/CT to predict lymph node metastases. PPV was 36% and NPV was 75%. Risk group analyses showed similar results. Conclusion: Our study emphasizes the poor performance of FCH PET/CT to predict lymph node metastasis in intermediate and high-risk prostate cancer. The method should be replaced with newer radiopharmaceuticals, such as prostate-specific membrane antigen ligands.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
lymph node dissection, metastases, PET/CT, Prostate cancer, robotic surgery, staging
in
Scandinavian Journal of Urology
volume
55
issue
4
pages
293 - 297
publisher
Taylor & Francis
external identifiers
  • pmid:33939583
  • scopus:85105219724
ISSN
2168-1805
DOI
10.1080/21681805.2021.1914720
language
English
LU publication?
yes
id
25a67bef-0e02-4ebc-ae27-29860cafdcbb
date added to LUP
2021-05-31 10:50:07
date last changed
2024-04-06 04:14:27
@article{25a67bef-0e02-4ebc-ae27-29860cafdcbb,
  abstract     = {{<p>Background: Previous studies have investigated [18F]-fluorocholine (FCH) positron emission tomography with computed tomography (PET/CT) in primary staging of men with intermediate or high-risk prostate cancer and have generally shown high specificity and poor sensitivity. FCH PET/CT is not recommended for the primary staging of metastases in the European guidelines for prostate cancer. However, it has been an option in the Swedish recommendations. Our aim was to assess PET/CT for primary staging of lymph node metastases before robotic-assisted laparoscopic prostatectomy (RALP) with extended pelvic lymph node dissection (ePLND) in patients with intermediate or high-risk prostate cancer. Method: We identified all men with prostate cancer undergoing FCH PET/CT for initial staging followed by RALP and ePLND at Skåne University Hospital between 2015 and 2018. The result from PET/CT scan was compared with pathology report as the reference method for calculation of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: In total, 252 patients were included in the final analysis. Among 85 patients with a suspicion of regional lymph node metastases on FCH PET/CT only 31 had pathology-proven metastases. The sensitivity was 43% (95% CI 0.32–0.55) and the specificity 70% (95% CI 0.63–0.76) for PET/CT to predict lymph node metastases. PPV was 36% and NPV was 75%. Risk group analyses showed similar results. Conclusion: Our study emphasizes the poor performance of FCH PET/CT to predict lymph node metastasis in intermediate and high-risk prostate cancer. The method should be replaced with newer radiopharmaceuticals, such as prostate-specific membrane antigen ligands.</p>}},
  author       = {{Puterman, Christopher and Bjöersdorff, Mimmi and Amidi, Jennifer and Anand, Aseem and Soller, Wolfgang and Jiborn, Thomas and Kjölhede, Henrik and Trägårdh, Elin and Bjartell, Anders}},
  issn         = {{2168-1805}},
  keywords     = {{lymph node dissection; metastases; PET/CT; Prostate cancer; robotic surgery; staging}},
  language     = {{eng}},
  month        = {{05}},
  number       = {{4}},
  pages        = {{293--297}},
  publisher    = {{Taylor & Francis}},
  series       = {{Scandinavian Journal of Urology}},
  title        = {{A retrospective study assessing the accuracy of [18F]–fluorocholine PET/CT for primary staging of lymph node metastases in intermediate and high-risk prostate cancer patients undergoing robotic-assisted laparoscopic prostatectomy with extended lymph node dissection}},
  url          = {{http://dx.doi.org/10.1080/21681805.2021.1914720}},
  doi          = {{10.1080/21681805.2021.1914720}},
  volume       = {{55}},
  year         = {{2021}},
}