PD27-01 PREDICTING EXTRA-PROSTATIC EXTENSION (EPE) FOR SURGICAL GUIDANCE IN PROSTATE CANCER: A COMPARISON OF BIOPSY PATHOLOGY, MULTIPARAMETRIC MRI, AND PSMA-PET (2022)

You have accessJournal of UrologyCME1 May 2022PD27-01 PREDICTING EXTRA-PROSTATIC EXTENSION (EPE) FOR SURGICAL GUIDANCE IN PROSTATE CANCER: A COMPARISON OF BIOPSY PATHOLOGY, MULTIPARAMETRIC MRI, AND PSMA-PET Clinton Bahler, Mark Green, Mark Tann, Katrina Collins, Jordan Swensson, Eric Brocken, Liang Cheng, Carla Mathias, David Alexoff, Hank Kung, Gary Hutchins, and Michael Koch Clinton BahlerClinton Bahler More articles by this author , Mark GreenMark Green More articles by this author , Mark TannMark Tann More articles by this author , Katrina CollinsKatrina Collins More articles by this author , Jordan SwenssonJordan Swensson More articles by this author , Eric BrockenEric Brocken More articles by this author , Liang ChengLiang Cheng More articles by this author , Carla MathiasCarla Mathias More articles by this author , David AlexoffDavid Alexoff More articles by this author , Hank KungHank Kung More articles by this author , Gary HutchinsGary Hutchins More articles by this author , and Michael KochMichael Koch More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002575.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostatectomy related incontinence and impotency result from injury to nerves and muscle tissue. Preserving nerves and muscle adjacent to the prostate risks positive margins; therefore, preoperative imaging is needed with high sensitivity for extra-prostatic extension. METHODS: Four clinical trials for PSMA-PET targeted imaging prior to prostatectomy were retrospectively evaluated for prediction of extra-prostatic extension as documented on post-surgical whole-mount pathologic analysis. Two different PSMA-PET tracers were included: PSMA-11 and P16-093. A blinded review of PET and MRI scans was performed to predict the risk of extra-prostatic extension (EPE). Stata 13.1 was used. Pearson’s Chi2 and McNemar’s Chi2 were used for accuracy statistics. RESULTS: Pre-operative PSMA-PET imaging was performed in 71 patients with either 68Ga-P16-093 (n=25) or 68Ga-PSMA-11 (n=46). Age (62 vs 61 years), PSA (7.3 vs 7.8), and biopsy pathology (3+3: 0 vs 7%, 3+4: 28 vs 39%, 4+3: 24 vs 20%, ≥4+5: 48 vs 35%) were similar between the groups (p >0.30). There were 24 (34%) with pT3a (EPE) and 16 (23%) with pT3b on final pathology. Overall positive margin rate was 17 (24%). Index lesion SUVmax was similar between P16-093 and PSMA-11 (10.3 vs 11.7). EPE Sensitivity (87 vs 92%), Specificity (77 vs 76%), and ROC area (82 vs 84%) were similar between P16-093 and PSMA-11, respectively (p=0.87). MRI (available in 45) found high specificity (83%) but low sensitivity (60%) and the overall ROC area was lower when compared to pooled PSMA-PET (0.72 vs 0.83, p=0.01). For pooled PSMA-PET imaging, a treatment change from “non-nerve sparing” to “nerve sparing” was recommended in 21/71 (30%) of patients. A total of 14 men had nerve-sparing (treatment change) based on PSMA-PET imaging with one (5%) having a positive margin. Figure 1 shows a case where left-sided EPE as accurately predicted by 68Ga-P16-093 scan. CONCLUSIONS: PSMA-PET imaging can improve surgical guidance in men with ≥4+3 prostate cancer resulting in preservation of nerve-bundles. 68Ga-P16-093 PET and 68Ga-PSMA-11 PET had similar accuracy for predicting extra-prostatic extension. Source of Funding: Al Christy Prostate Cancer Fund, R44 CA233140, NIH Small Business Innovation Research grant (SBIR), CTSI NIH/NCRR Grant Number UL1TR001108, ACS-IRG Grant Mechanism (16-192-31) © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e493 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Clinton Bahler More articles by this author Mark Green More articles by this author Mark Tann More articles by this author Katrina Collins More articles by this author Jordan Swensson More articles by this author Eric Brocken More articles by this author Liang Cheng More articles by this author Carla Mathias More articles by this author David Alexoff More articles by this author Hank Kung More articles by this author Gary Hutchins More articles by this author Michael Koch More articles by this author Expand All Advertisement PDF DownloadLoading ...