Assessing the accuracy of [<sup>18</sup>F]PSMA-1007 PET/CT for primary staging of lymph node metastases in intermediate- and high-risk prostate cancer patients

Ingvar, Jacob; Hvittfeldt, Erland; Trägårdh, Elin; Simoulis, Athanasios; Bjartell, Anders

Assessing the accuracy of [¹⁸F]PSMA-1007 PET/CT for primary staging of lymph node metastases in intermediate- and high-risk prostate cancer patients

Mark

Ingvar, Jacob ^LU ; Hvittfeldt, Erland ^LU

; Trägårdh, Elin ^LU ; Simoulis, Athanasios ^LU

and Bjartell, Anders ^LU (2022) In EJNMMI Research 12(1).

Abstract: Background: [¹⁸F]PSMA-1007 is a promising tracer for integrated positron emission tomography and computed tomography (PET/CT). Objective: Our aim was to assess the diagnostic accuracy of [¹⁸F]PSMA-1007 PET/CT for primary staging of lymph node metastasis before robotic-assisted laparoscopy (RALP) with extended lymph node dissection (ePLND). Design, Setting and Participants: The study was a retrospective cohort in a tertiary referral center. Men with prostate cancer that underwent surgical treatment for intermediate- or high-risk prostate cancer between May 2019 and August 2021 were included. Interventions: [¹⁸F]PSMA-1007 PET/CT for initial staging followed by RALP and ePLND. Outcome measurements and... (More); Background: [¹⁸F]PSMA-1007 is a promising tracer for integrated positron emission tomography and computed tomography (PET/CT). Objective: Our aim was to assess the diagnostic accuracy of [¹⁸F]PSMA-1007 PET/CT for primary staging of lymph node metastasis before robotic-assisted laparoscopy (RALP) with extended lymph node dissection (ePLND). Design, Setting and Participants: The study was a retrospective cohort in a tertiary referral center. Men with prostate cancer that underwent surgical treatment for intermediate- or high-risk prostate cancer between May 2019 and August 2021 were included. Interventions: [¹⁸F]PSMA-1007 PET/CT for initial staging followed by RALP and ePLND. Outcome measurements and statistical analyses: Sensitivity and specificity were calculated both for the entire cohort and for patients with lymph node metastasis ≥ 3 mm. Positive (PPV) and negative (NPV) predictive values were calculated. Results and limitations: Among 104 patients included in the analyses, 26 patients had lymph node metastasis based on pathology reporting and metastases were ≥ 3 mm in size in 13 of the cases (50%). In the entire cohort, the sensitivity and specificity of [¹⁸F]PSMA-1007 were 26.9% (95% confidence interval (CI); 11.6–47.8) and 96.2% (95% CI; 89.2–99.2), respectively. The sensitivity and specificity of [¹⁸F]PSMA-1007 to detect a lymph node metastasis ≥ 3 mm on PET/CT were 53.8% (95% CI; 25.1–80.8) and 96.7% (95% CI; 90.7–99.3), respectively. PPV was 70% and NPV 93.6%. Conclusions: In primary staging of intermediate- and high-risk prostate cancer, [¹⁸F]PSMA-1007 PET/CT is highly specific for prediction of lymph node metastases, but the sensitivity for detection of metastases smaller than 3 mm is limited. Based on our results, [¹⁸F]PSMA-1007 PET/CT cannot completely replace ePLND. Patient summary: This study investigated the use of an imaging method based on a prostate antigen-specific radiopharmaceutical tracer to detect lymph node prostate cancer metastasis. We found that it is unreliable to discover small metastasis.
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Please use this url to cite or link to this publication: https://lup.lub.lu.se/record/fa5a4c64-e585-41d3-be9b-c368255d1c76

author

Ingvar, Jacob ^LU ; Hvittfeldt, Erland ^LU

; Trägårdh, Elin ^LU ; Simoulis, Athanasios ^LU

and Bjartell, Anders ^LU

organization

publishing date

2022

type

Contribution to journal

publication status

published

subject

keywords

Lymph node dissection, Metastases, PET/CT, Prostate cancer, Robotic surgery, Staging

in

EJNMMI Research

volume

12

issue

1

article number

48

publisher

BioMed Central (BMC)

external identifiers

pmid:35943665
scopus:85135802117

ISSN

2191-219X

DOI

10.1186/s13550-022-00918-7

language

English

LU publication?

yes

id

fa5a4c64-e585-41d3-be9b-c368255d1c76

date added to LUP

2022-09-23 11:35:05

date last changed

2024-06-25 03:03:58

@article{fa5a4c64-e585-41d3-be9b-c368255d1c76,
  abstract     = {{<p>Background: [<sup>18</sup>F]PSMA-1007 is a promising tracer for integrated positron emission tomography and computed tomography (PET/CT). Objective: Our aim was to assess the diagnostic accuracy of [<sup>18</sup>F]PSMA-1007 PET/CT for primary staging of lymph node metastasis before robotic-assisted laparoscopy (RALP) with extended lymph node dissection (ePLND). Design, Setting and Participants: The study was a retrospective cohort in a tertiary referral center. Men with prostate cancer that underwent surgical treatment for intermediate- or high-risk prostate cancer between May 2019 and August 2021 were included. Interventions: [<sup>18</sup>F]PSMA-1007 PET/CT for initial staging followed by RALP and ePLND. Outcome measurements and statistical analyses: Sensitivity and specificity were calculated both for the entire cohort and for patients with lymph node metastasis ≥ 3 mm. Positive (PPV) and negative (NPV) predictive values were calculated. Results and limitations: Among 104 patients included in the analyses, 26 patients had lymph node metastasis based on pathology reporting and metastases were ≥ 3 mm in size in 13 of the cases (50%). In the entire cohort, the sensitivity and specificity of [<sup>18</sup>F]PSMA-1007 were 26.9% (95% confidence interval (CI); 11.6–47.8) and 96.2% (95% CI; 89.2–99.2), respectively. The sensitivity and specificity of [<sup>18</sup>F]PSMA-1007 to detect a lymph node metastasis ≥ 3 mm on PET/CT were 53.8% (95% CI; 25.1–80.8) and 96.7% (95% CI; 90.7–99.3), respectively. PPV was 70% and NPV 93.6%. Conclusions: In primary staging of intermediate- and high-risk prostate cancer, [<sup>18</sup>F]PSMA-1007 PET/CT is highly specific for prediction of lymph node metastases, but the sensitivity for detection of metastases smaller than 3 mm is limited. Based on our results, [<sup>18</sup>F]PSMA-1007 PET/CT cannot completely replace ePLND. Patient summary: This study investigated the use of an imaging method based on a prostate antigen-specific radiopharmaceutical tracer to detect lymph node prostate cancer metastasis. We found that it is unreliable to discover small metastasis.</p>}},
  author       = {{Ingvar, Jacob and Hvittfeldt, Erland and Trägårdh, Elin and Simoulis, Athanasios and Bjartell, Anders}},
  issn         = {{2191-219X}},
  keywords     = {{Lymph node dissection; Metastases; PET/CT; Prostate cancer; Robotic surgery; Staging}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{EJNMMI Research}},
  title        = {{Assessing the accuracy of [<sup>18</sup>F]PSMA-1007 PET/CT for primary staging of lymph node metastases in intermediate- and high-risk prostate cancer patients}},
  url          = {{http://dx.doi.org/10.1186/s13550-022-00918-7}},
  doi          = {{10.1186/s13550-022-00918-7}},
  volume       = {{12}},
  year         = {{2022}},
}

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Assessing the accuracy of [¹⁸F]PSMA-1007 PET/CT for primary staging of lymph node metastases in intermediate- and high-risk prostate cancer patients