Objective
To assess the diagnostic accuracy of 64Copper prostate-specific membrane antigen (64Cu-PSMA) positron emission tomography/computed tomography (PET/CT) in the primary
lymph node (LN) staging of a selected cohort of intermediate- to high-risk prostate
cancer (PCa) patients.
Materials and Methods
An observational prospective study was performed in 23 patients with intermediate-
to high-risk PCa, who underwent 64Cu-PSMA PET/CT for local and lymph nodal staging before laparoscopic radical prostatectomy
with an extended pelvic LN dissection.
The sensitivity, specificity, positive predictive value (PPV), and negative predictive
value (NPV) for LN status of 64Cu-PSMA PET/CT were calculated using the final pathological findings as reference.
Furthermore, we evaluated the correlation of intraprostatic tumor extent and grading
with 64Cu-PSMA intraprostatic distribution.
Results
Pathological analysis of LN involvement in 413 LNs harvested from our study cohort
identified a total of 22 LN metastases in 8 (5%) of the 23 (35%) PCa patients. Imaging-based
LN staging in a per-patient analysis showed that 64Cu-PSMA PET/CT was positive in 7 of 8 LN-positive patients (22%) with a sensitivity
of 87.5%, specificity of 100%, PPV of 100%, and NPV of 93.7%, considering the maximum
standardized uptake value (SUVmax) at 4 hours as our reference. Receiver operating characteristic curve was characterized
by an area under the curve of 0.938.
A significant positive association was observed between SUVmax at 4 hours with Gleason score, index, and cumulative tumor volume.
Conclusion
In our intermediate- to high-risk PCa patients study cohort, we showed the high diagnostic
accuracy of 64Cu-PSMA PET/CT for primary LN staging before radical prostatectomy.
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Article info
Publication history
Published online: April 21, 2017
Accepted:
April 14,
2017
Received:
March 8,
2017
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
