The role of 68Gallium-prostate-specific membrane antigen positron emission tomography on staging of high-risk localized prostate cancer: for all high-risk patients or would it be better to select them?

摘要

BackgroundAccording to pathologico-clinical features, patients diagnosed with localized prostate cancer (PCa) are stratified into distinct risk groups (low-risk, intermediate-risk or high-risk). Data have demonstrated that68Gallium-prostate-specific membrane antigen positron emission tomography (68Ga-PSMA PET/CT) is superior to conventional radiological exams (CT or MRI and bone scintigraphy) in the primary staging of high-risk localized PCa. However, it is still unknown if in a population of high-risk PCa, there would be a subgroup of patients with a higher probability of identifying metastatic disease by the68Ga-PSMA PET/CT.Materials and MethodsData from patients with localized PCa who underwent68GA-PSMA PET/CT for primary staging from four institutions were retrospectively collected. We selected patients with at least one D'Amico classification risk factor (International Society of Urological Pathology?≥?IV and/or prostate-specific antigen?>?20?ng/ml). To detect an association between extent of disease and number of risk factors as well as International Society of Urological Pathology prostate cancer grade, contingency tables were used, and Fisher Exact Test was performed.ResultsBetween 2016 and 2020, 60 patients underwent a68GA-PSMA PET/CT for primary staging of high-risk localized PCa. Regarding the number of risk factors, 37 patients (62%) had one risk factor, and 23 (38%) had two risk factors. In the subgroup of patients with metastatic disease (n?=?22), those with two risk factors had higher incidence of metastatic disease, and it was statistically significant (p?=?0.011).ConclusionThis retrospective analysis demonstrated that68GA-PSMA PET/CT was able to identify advanced disease in more than one-third of patients with high-risk disease especially those with two adverse risk factors.