Assessing extra-prostatic extension for surgical guidance in prostate cancer: Comparing two PSMA-PET tracers with the standard-of-care
•Presurgical PSMA-PET appeared useful as a tool for surgical planning.•Up to 30% of patients had a recommended treatment change to nerve-sparing surgery.•Both PSMA-PET tracers, 68Ga-PSMA-11 and 68Ga-P16-093 performed similarly. Incontinence and impotence occur following radical prostatectomy due to...
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| Veröffentlicht in: | Urologic oncology 2023-01, Vol.41 (1), p.48.e1-48.e9 |
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| creator | Bahler, Clinton D. Green, Mark A. Tann, Mark A. Swensson, Jordan K. Collins, Katrina Alexoff, David Kung, Hank Brocken, Eric Mathias, Carla J. Cheng, Liang Hutchins, Gary D. Koch, Michael O. |
| description | •Presurgical PSMA-PET appeared useful as a tool for surgical planning.•Up to 30% of patients had a recommended treatment change to nerve-sparing surgery.•Both PSMA-PET tracers, 68Ga-PSMA-11 and 68Ga-P16-093 performed similarly.
Incontinence and impotence occur following radical prostatectomy due to injury to nerves and sphincter muscle. Preserving nerves and muscle adjacent to prostate cancer risks positive surgical margins. Advanced imaging with MRI has improved cancer localization but limitations exist.
To measure the accuracy for assessing extra-prostatic extension at nerve bundles for 2 PSMA-PET tracers and to compare the PET accuracy to standard-of-care predictors including MRI and biopsy results.
We studied men with PSMA-targeted PET imaging, performed prior to prostatectomy in men largely with intermediate to high-risk prostate cancer, and retrospectively evaluated for assessment of extra-prostatic extension with whole-mount analysis as reference standard. Two different PSMA-PET tracers were included: 68Ga-PSMA-11 and 68Ga-P16-093. Blinded reviews of the PET and MRI scans were performed to assess extra-prostatic extension (EPE). Sensitivity and specificity for extra-prostatic extension were compared using McNemar's Chi2.
Pre-operative PSMA-PET imaging was available for 71 patients with either 68Ga-P16-093 (n = 25) or 68Ga-PSMA-11 (n = 46). There were 24 (34%) with pT3a (EPE) and 16 (23%) with pT3b (SVI). EPE Sensitivity (87% vs. 92%), Specificity (77% vs. 76%), and ROC area (0.82 vs. 0.84) were similar between P16-093 and PSMA-11, respectively (P = 0.87). MRI (available in only 45) found high specificity (83%) but low sensitivity (60%) for EPE when using a published grading system. MRI sensitivity was significantly lower than the PSMA-PET (60% vs. 90%, P = 0.02), but similar to PET when using a >5 mm capsular contact (76% vs. 90%, P = 0.38). A treatment change to “nerve sparing” was recommended in 21 of 71 (30%) patients based on PSMA-PET imaging.
Presurgical PSMA-PET appeared useful as a tool for surgical planning, changing treatment plans in men with ≥4+3 or multi-core 3+4 prostate cancer resulting in preservation of nerve-bundles. |
| doi_str_mv | 10.1016/j.urolonc.2022.10.003 |
| format | Article |
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Incontinence and impotence occur following radical prostatectomy due to injury to nerves and sphincter muscle. Preserving nerves and muscle adjacent to prostate cancer risks positive surgical margins. Advanced imaging with MRI has improved cancer localization but limitations exist.
To measure the accuracy for assessing extra-prostatic extension at nerve bundles for 2 PSMA-PET tracers and to compare the PET accuracy to standard-of-care predictors including MRI and biopsy results.
We studied men with PSMA-targeted PET imaging, performed prior to prostatectomy in men largely with intermediate to high-risk prostate cancer, and retrospectively evaluated for assessment of extra-prostatic extension with whole-mount analysis as reference standard. Two different PSMA-PET tracers were included: 68Ga-PSMA-11 and 68Ga-P16-093. Blinded reviews of the PET and MRI scans were performed to assess extra-prostatic extension (EPE). Sensitivity and specificity for extra-prostatic extension were compared using McNemar's Chi2.
Pre-operative PSMA-PET imaging was available for 71 patients with either 68Ga-P16-093 (n = 25) or 68Ga-PSMA-11 (n = 46). There were 24 (34%) with pT3a (EPE) and 16 (23%) with pT3b (SVI). EPE Sensitivity (87% vs. 92%), Specificity (77% vs. 76%), and ROC area (0.82 vs. 0.84) were similar between P16-093 and PSMA-11, respectively (P = 0.87). MRI (available in only 45) found high specificity (83%) but low sensitivity (60%) for EPE when using a published grading system. MRI sensitivity was significantly lower than the PSMA-PET (60% vs. 90%, P = 0.02), but similar to PET when using a >5 mm capsular contact (76% vs. 90%, P = 0.38). A treatment change to “nerve sparing” was recommended in 21 of 71 (30%) patients based on PSMA-PET imaging.
Presurgical PSMA-PET appeared useful as a tool for surgical planning, changing treatment plans in men with ≥4+3 or multi-core 3+4 prostate cancer resulting in preservation of nerve-bundles.</description><identifier>ISSN: 1078-1439</identifier><identifier>ISSN: 1873-2496</identifier><identifier>EISSN: 1873-2496</identifier><identifier>DOI: 10.1016/j.urolonc.2022.10.003</identifier><identifier>PMID: 36333187</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Gallium Radioisotopes ; Humans ; Male ; Pathology ; PET scan ; Positron-Emission Tomography - methods ; Prostate cancer ; Prostatectomy ; Prostatic Neoplasms - diagnostic imaging ; Prostatic Neoplasms - pathology ; Prostatic Neoplasms - surgery ; Quality of life ; Retrospective Studies</subject><ispartof>Urologic oncology, 2023-01, Vol.41 (1), p.48.e1-48.e9</ispartof><rights>2022 Elsevier Inc.</rights><rights>Copyright © 2022 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c365t-bc26439fd4fa301ea13091f9315cd988532e31b0b5e33a024c34e5d48dce50e33</citedby><cites>FETCH-LOGICAL-c365t-bc26439fd4fa301ea13091f9315cd988532e31b0b5e33a024c34e5d48dce50e33</cites><orcidid>0000-0003-0484-801X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1078143922003593$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36333187$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bahler, Clinton D.</creatorcontrib><creatorcontrib>Green, Mark A.</creatorcontrib><creatorcontrib>Tann, Mark A.</creatorcontrib><creatorcontrib>Swensson, Jordan K.</creatorcontrib><creatorcontrib>Collins, Katrina</creatorcontrib><creatorcontrib>Alexoff, David</creatorcontrib><creatorcontrib>Kung, Hank</creatorcontrib><creatorcontrib>Brocken, Eric</creatorcontrib><creatorcontrib>Mathias, Carla J.</creatorcontrib><creatorcontrib>Cheng, Liang</creatorcontrib><creatorcontrib>Hutchins, Gary D.</creatorcontrib><creatorcontrib>Koch, Michael O.</creatorcontrib><title>Assessing extra-prostatic extension for surgical guidance in prostate cancer: Comparing two PSMA-PET tracers with the standard-of-care</title><title>Urologic oncology</title><addtitle>Urol Oncol</addtitle><description>•Presurgical PSMA-PET appeared useful as a tool for surgical planning.•Up to 30% of patients had a recommended treatment change to nerve-sparing surgery.•Both PSMA-PET tracers, 68Ga-PSMA-11 and 68Ga-P16-093 performed similarly.
Incontinence and impotence occur following radical prostatectomy due to injury to nerves and sphincter muscle. Preserving nerves and muscle adjacent to prostate cancer risks positive surgical margins. Advanced imaging with MRI has improved cancer localization but limitations exist.
To measure the accuracy for assessing extra-prostatic extension at nerve bundles for 2 PSMA-PET tracers and to compare the PET accuracy to standard-of-care predictors including MRI and biopsy results.
We studied men with PSMA-targeted PET imaging, performed prior to prostatectomy in men largely with intermediate to high-risk prostate cancer, and retrospectively evaluated for assessment of extra-prostatic extension with whole-mount analysis as reference standard. Two different PSMA-PET tracers were included: 68Ga-PSMA-11 and 68Ga-P16-093. Blinded reviews of the PET and MRI scans were performed to assess extra-prostatic extension (EPE). Sensitivity and specificity for extra-prostatic extension were compared using McNemar's Chi2.
Pre-operative PSMA-PET imaging was available for 71 patients with either 68Ga-P16-093 (n = 25) or 68Ga-PSMA-11 (n = 46). There were 24 (34%) with pT3a (EPE) and 16 (23%) with pT3b (SVI). EPE Sensitivity (87% vs. 92%), Specificity (77% vs. 76%), and ROC area (0.82 vs. 0.84) were similar between P16-093 and PSMA-11, respectively (P = 0.87). MRI (available in only 45) found high specificity (83%) but low sensitivity (60%) for EPE when using a published grading system. MRI sensitivity was significantly lower than the PSMA-PET (60% vs. 90%, P = 0.02), but similar to PET when using a >5 mm capsular contact (76% vs. 90%, P = 0.38). A treatment change to “nerve sparing” was recommended in 21 of 71 (30%) patients based on PSMA-PET imaging.
Presurgical PSMA-PET appeared useful as a tool for surgical planning, changing treatment plans in men with ≥4+3 or multi-core 3+4 prostate cancer resulting in preservation of nerve-bundles.</description><subject>Gallium Radioisotopes</subject><subject>Humans</subject><subject>Male</subject><subject>Pathology</subject><subject>PET scan</subject><subject>Positron-Emission Tomography - methods</subject><subject>Prostate cancer</subject><subject>Prostatectomy</subject><subject>Prostatic Neoplasms - diagnostic imaging</subject><subject>Prostatic Neoplasms - pathology</subject><subject>Prostatic Neoplasms - surgery</subject><subject>Quality of life</subject><subject>Retrospective Studies</subject><issn>1078-1439</issn><issn>1873-2496</issn><issn>1873-2496</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUctuGyEURVWq5tVPaMUyGxzgzoxnsqksK2kipaqluGuE4Y6DNR5cYOLmB_rdZWSn26yAwznnPg4hXwSfCC6q681kCL7zvZlILmXGJpzDB3Im6ikwWTTVSb7zac1EAc0pOY9xw7koaiE-kVOoACAzz8jfWYwYo-vXFP-koNku-Jh0cmZ8Yx-d72nrA41DWDujO7oenNW9Qep6eiQjNSMSbujcb3c6jG5p7-ni6ceMLW6XNBvn70j3Lj3T9Iw0q3qrg2W-ZUYHvCQfW91F_Hw8L8ivu9vl_J49_vz-MJ89MgNVmdjKyCqP09qi1cAFagG8EW0DojS2qesSJIJY8VWJAJrLwkCBpS1qa7DkGbsgVwff3PnvAWNSWxcNdp3u0Q9RySnIsgAxHanlgWrykDFgq3bBbXV4VYKrMQK1UccI1BjBCOcIsu7rscSw2qL9r3rbeSZ8OxAwD_riMKhoHOb9WRfQJGW9e6fEP6w5nE0</recordid><startdate>202301</startdate><enddate>202301</enddate><creator>Bahler, Clinton D.</creator><creator>Green, Mark A.</creator><creator>Tann, Mark A.</creator><creator>Swensson, Jordan K.</creator><creator>Collins, Katrina</creator><creator>Alexoff, David</creator><creator>Kung, Hank</creator><creator>Brocken, Eric</creator><creator>Mathias, Carla J.</creator><creator>Cheng, Liang</creator><creator>Hutchins, Gary D.</creator><creator>Koch, Michael O.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0484-801X</orcidid></search><sort><creationdate>202301</creationdate><title>Assessing extra-prostatic extension for surgical guidance in prostate cancer: Comparing two PSMA-PET tracers with the standard-of-care</title><author>Bahler, Clinton D. ; Green, Mark A. ; Tann, Mark A. ; Swensson, Jordan K. ; Collins, Katrina ; Alexoff, David ; Kung, Hank ; Brocken, Eric ; Mathias, Carla J. ; Cheng, Liang ; Hutchins, Gary D. ; Koch, Michael O.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c365t-bc26439fd4fa301ea13091f9315cd988532e31b0b5e33a024c34e5d48dce50e33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Gallium Radioisotopes</topic><topic>Humans</topic><topic>Male</topic><topic>Pathology</topic><topic>PET scan</topic><topic>Positron-Emission Tomography - methods</topic><topic>Prostate cancer</topic><topic>Prostatectomy</topic><topic>Prostatic Neoplasms - diagnostic imaging</topic><topic>Prostatic Neoplasms - pathology</topic><topic>Prostatic Neoplasms - surgery</topic><topic>Quality of life</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bahler, Clinton D.</creatorcontrib><creatorcontrib>Green, Mark A.</creatorcontrib><creatorcontrib>Tann, Mark A.</creatorcontrib><creatorcontrib>Swensson, Jordan K.</creatorcontrib><creatorcontrib>Collins, Katrina</creatorcontrib><creatorcontrib>Alexoff, David</creatorcontrib><creatorcontrib>Kung, Hank</creatorcontrib><creatorcontrib>Brocken, Eric</creatorcontrib><creatorcontrib>Mathias, Carla J.</creatorcontrib><creatorcontrib>Cheng, Liang</creatorcontrib><creatorcontrib>Hutchins, Gary D.</creatorcontrib><creatorcontrib>Koch, Michael O.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Urologic oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bahler, Clinton D.</au><au>Green, Mark A.</au><au>Tann, Mark A.</au><au>Swensson, Jordan K.</au><au>Collins, Katrina</au><au>Alexoff, David</au><au>Kung, Hank</au><au>Brocken, Eric</au><au>Mathias, Carla J.</au><au>Cheng, Liang</au><au>Hutchins, Gary D.</au><au>Koch, Michael O.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessing extra-prostatic extension for surgical guidance in prostate cancer: Comparing two PSMA-PET tracers with the standard-of-care</atitle><jtitle>Urologic oncology</jtitle><addtitle>Urol Oncol</addtitle><date>2023-01</date><risdate>2023</risdate><volume>41</volume><issue>1</issue><spage>48.e1</spage><epage>48.e9</epage><pages>48.e1-48.e9</pages><issn>1078-1439</issn><issn>1873-2496</issn><eissn>1873-2496</eissn><abstract>•Presurgical PSMA-PET appeared useful as a tool for surgical planning.•Up to 30% of patients had a recommended treatment change to nerve-sparing surgery.•Both PSMA-PET tracers, 68Ga-PSMA-11 and 68Ga-P16-093 performed similarly.
Incontinence and impotence occur following radical prostatectomy due to injury to nerves and sphincter muscle. Preserving nerves and muscle adjacent to prostate cancer risks positive surgical margins. Advanced imaging with MRI has improved cancer localization but limitations exist.
To measure the accuracy for assessing extra-prostatic extension at nerve bundles for 2 PSMA-PET tracers and to compare the PET accuracy to standard-of-care predictors including MRI and biopsy results.
We studied men with PSMA-targeted PET imaging, performed prior to prostatectomy in men largely with intermediate to high-risk prostate cancer, and retrospectively evaluated for assessment of extra-prostatic extension with whole-mount analysis as reference standard. Two different PSMA-PET tracers were included: 68Ga-PSMA-11 and 68Ga-P16-093. Blinded reviews of the PET and MRI scans were performed to assess extra-prostatic extension (EPE). Sensitivity and specificity for extra-prostatic extension were compared using McNemar's Chi2.
Pre-operative PSMA-PET imaging was available for 71 patients with either 68Ga-P16-093 (n = 25) or 68Ga-PSMA-11 (n = 46). There were 24 (34%) with pT3a (EPE) and 16 (23%) with pT3b (SVI). EPE Sensitivity (87% vs. 92%), Specificity (77% vs. 76%), and ROC area (0.82 vs. 0.84) were similar between P16-093 and PSMA-11, respectively (P = 0.87). MRI (available in only 45) found high specificity (83%) but low sensitivity (60%) for EPE when using a published grading system. MRI sensitivity was significantly lower than the PSMA-PET (60% vs. 90%, P = 0.02), but similar to PET when using a >5 mm capsular contact (76% vs. 90%, P = 0.38). A treatment change to “nerve sparing” was recommended in 21 of 71 (30%) patients based on PSMA-PET imaging.
Presurgical PSMA-PET appeared useful as a tool for surgical planning, changing treatment plans in men with ≥4+3 or multi-core 3+4 prostate cancer resulting in preservation of nerve-bundles.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>36333187</pmid><doi>10.1016/j.urolonc.2022.10.003</doi><orcidid>https://orcid.org/0000-0003-0484-801X</orcidid></addata></record> |
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| ispartof | Urologic oncology, 2023-01, Vol.41 (1), p.48.e1-48.e9 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Gallium Radioisotopes Humans Male Pathology PET scan Positron-Emission Tomography - methods Prostate cancer Prostatectomy Prostatic Neoplasms - diagnostic imaging Prostatic Neoplasms - pathology Prostatic Neoplasms - surgery Quality of life Retrospective Studies |
| title | Assessing extra-prostatic extension for surgical guidance in prostate cancer: Comparing two PSMA-PET tracers with the standard-of-care |
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